1417952268 NPI number — DIALYSIS CLINIC INC

Table of content: (NPI 1417952268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417952268 NPI number — DIALYSIS CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIALYSIS CLINIC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DCI LAB NASHVILLE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417952268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2917 FOSTER CREIGHTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37204-3705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-255-5227
Provider Business Mailing Address Fax Number:
615-259-9321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2917 FOSTER CREIGHTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37204-3705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-255-5227
Provider Business Practice Location Address Fax Number:
615-259-9321
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
DONOVAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-327-3061

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  TN 1953 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 37901988 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003112836 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00380388A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1970426 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4909-843025A3 . This is a "NEW YORK LAB LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DC 702702903 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 021177 . This is a "PA LAB LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007529840006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: COS 800031 . This is a "CA LAB LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: XLAB00790 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44D0659053 . This is a "CLIA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 003400559 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800011550 . This is a "FL LAB LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 052598 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100018440A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20884257 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74472 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0805076 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: TN 1953 . This is a "STATE LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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