Provider Demographics
NPI:1710406301
Name:DIALYSIS CLINIC INC
Entity Type:Organization
Organization Name:DIALYSIS CLINIC INC
Other - Org Name:DIALYSIS CLINIC INC - SOUTHWEST MESA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-327-3061
Mailing Address - Street 1:1500 INDIAN SCHOOL RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1646
Mailing Address - Country:US
Mailing Address - Phone:505-724-1500
Mailing Address - Fax:505-724-1526
Practice Address - Street 1:8121 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-2125
Practice Address - Country:US
Practice Address - Phone:505-836-1061
Practice Address - Fax:505-836-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment