Provider Demographics
NPI:1881854396
Name:DIALYSIS CLINIC INC.
Entity Type:Organization
Organization Name:DIALYSIS CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-327-3061
Mailing Address - Street 1:139 W HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:MC CRORY
Mailing Address - State:AR
Mailing Address - Zip Code:72101-8263
Mailing Address - Country:US
Mailing Address - Phone:870-731-0220
Mailing Address - Fax:870-731-0223
Practice Address - Street 1:139 W HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MC CRORY
Practice Address - State:AR
Practice Address - Zip Code:72101-8263
Practice Address - Country:US
Practice Address - Phone:870-731-0220
Practice Address - Fax:870-731-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR174741134Medicaid
AR042583Medicare Oscar/Certification