Provider Demographics
NPI:1841235850
Name:DIALYSIS CLINIC INC
Entity Type:Organization
Organization Name:DIALYSIS CLINIC INC
Other - Org Name:DCI PHARMACY SERVICES
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 1:2911 FOSTER CREIGHTON DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3705
Mailing Address - Country:US
Mailing Address - Phone:615-259-2426
Mailing Address - Fax:615-259-2862
Practice Address - Street 1:2911 FOSTER CREIGHTON DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3705
Practice Address - Country:US
Practice Address - Phone:615-259-2426
Practice Address - Fax:615-259-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100331483336M0002X
MDP053923336M0002X
NC106743336M0002X
COOSP-59163336M0002X
FLPH249243336M0002X
LAOS-0064273336M0002X
IN64001119A3336M0002X
AL1133443336M0002X
KYTN14973336M0002X
IA39503336M0002X
CTPCN00022043336M0002X
KS22-028063336M0002X
MT29393336M0002X
MEMO400011003336M0002X
GAPHNR0003333336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093259OtherPK
TN3543917Medicaid