Provider Demographics
NPI:1780689505
Name:DIALYSIS CLINIC INC
Entity Type:Organization
Organization Name:DIALYSIS CLINIC INC
Other - Org Name:DCI TRANSPLANT IMMUNOLOGY LABORATORY
Other - Org Type:Other Name
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 1:1616 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-3011
Mailing Address - Country:US
Mailing Address - Phone:615-321-0212
Mailing Address - Fax:615-321-4880
Practice Address - Street 1:1616 HAYES ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-3011
Practice Address - Country:US
Practice Address - Phone:615-321-0212
Practice Address - Fax:615-321-4880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIALYSIS CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-17
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN 1952291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN05-3-TN-06-1OtherASHI LAB NUMBER
TN44D0659038OtherCLIA
TNTN 1952OtherSTATE LABORATORY LICENSE
TN44-HL-01Medicare ID - Type UnspecifiedHISTO LAB PROVIDER ID