Dialysis Clinic Inc.
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Jeannette, PA
NPI 1639102015 · NPPES record last updated Oct 4, 2023
Key facts
- NPI
- 1639102015
- 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
- 6710 Route 30
Jeannette, PA 15644-3172 - Phone
- (724) 523-6386
- Fax
- (724) 523-9430
- 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) 20
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
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 |
|---|---|---|---|---|
| O20100315000871 | PA | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 4284541129 | Practice locations: Jeannette, PA |
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
6710 Route 30
Jeannette, PA 15644-3172
Mailing address
6710 Route 30
Jeannette, PA 15644-3172
Phone (724) 523-6386
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1412984 | Medicaid | PA | |
| 1007529840019 | Medicaid | PA |
Other providers in Jeannette, PA
- Jill M. Constantine
- Cornerstone Caregiving East LLC
- Corey Dailey
- Katarina Nicole Denardo
- John Richard Dent
- Rebecca Helen Dickinson
- Domenick P Diloreto
- Jennifer Divecchio
- Chelsea Divella
- Anna Elizabeth Donofrio
All providers in Jeannette, PA · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Pennsylvania
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.