Dialysis Clinic Inc.
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Moberly, MO
NPI 1215960604 · NPPES record last updated Oct 4, 2023
Key facts
- NPI
- 1215960604
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- DIALYSIS CLINIC INC.
- Practice address
- 1511 Union Ave
Moberly, MO 65270-9407 - Phone
- (660) 263-1611
- Fax
- (660) 263-2478
- 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) 16
Affiliated clinicians 2
-
Kurt Daniel Tarwater, M.D.
Medicare Care Compare: Dialysis facility
- Listed as
- Dialysis Clinics, Inc - Moberly
- Overall star rating
- ★★☆☆☆ 2.0 of 5
- Ownership
- Non-profit
- Certified
- Apr 13, 1999
- Medicare certification status
- Active
- Chain
- Dialysis Clinic, Inc.
- Dialysis stations
- 12
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0968275 | Dialysis Clinic Inc Moberly | Certificate of waiver | Feb 9, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
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 |
|---|---|---|---|---|
| O20100820001019 | MO | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 4284541129 | Practice locations: Moberly, MO |
National Provider Directory
- Tax ID family
- Elbert P Tuttle Jr MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
1511 Union Ave
Moberly, MO 65270-9407
Mailing address
1511 Union Ave
Moberly, MO 65270-9407
Phone (660) 263-1611
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 504684002 | Medicaid | MO |
Other providers in Moberly, MO
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- Jill R Darwent
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- Joshua David Delozier
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- Alexandra Elizabeth Dockins
- Adriana Duran
- E Medical Group of Missouri No 3 LLC
- Jerry Scott Eames
- Elizabeth Anne East
All providers in Moberly, MO · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Missouri
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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.