Dialysis Clinic Inc.
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Elmsford, NY
NPI 1114950508 · NPPES record last updated Oct 4, 2023
Key facts
- NPI
- 1114950508
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- 5957203R (NY)
- Legal business name
- DIALYSIS CLINIC INC.
- Practice address
- 234 E Main St
Elmsford, NY 10523-3423 - Phone
- (914) 592-5858
- Fax
- (914) 592-1595
- NPI assigned
- Jul 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Donovan Schultz
- Title
- President
- Phone
- (615) 327-3061
Corporate family (same tax ID) 15
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Rancho Dialysis Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Dec 24, 2003 Dec 24, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100414000577 | NY | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 4284541129 | Practice locations: Elmsford, NY |
National Provider Directory
- Tax ID family
- Elbert P Tuttle Jr MD
Locations
234 E Main St
Ste 200
Elmsford, NY 10523
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 5957203R | NY | Yes |
Addresses
Primary practice location
234 E Main St
Elmsford, NY 10523-3423
Mailing address
234 E Main St
Elmsford, NY 10523-3423
Phone (914) 592-5858
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39204235 | Medicaid | CO | |
| 02301357 | Medicaid | NY |
Other providers in Elmsford, NY
- Nicole Deangelis
- Samantha Delaney
- Celenia Delapp
- Jodyann Dell
- Anthony Joseph Delucci
- Danielle Moskow Diamond
- Tonia Dimbo
- Navette Doman-Wright
- Lisa Doris
- Mariatheresa Dy
All providers in Elmsford, NY · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.