Dialysis Clinic Inc.
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Lexington, TN
NPI 1770516254 · NPPES record last updated Oct 5, 2023
Key facts
- NPI
- 1770516254
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- 0000000152 (TN)
- Legal business name
- DIALYSIS CLINIC INC.
- Practice address
- 870 W Church St
Suite C
Lexington, TN 38351-1741 - Phone
- (731) 968-2513
- Fax
- (731) 968-2514
- 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) 18
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
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 |
|---|---|---|---|---|
| O20050428000281 | TN | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 4284541129 | Practice locations: Lexington, TN |
National Provider Directory
- Tax ID family
- Elbert P Tuttle Jr MD
Locations
870 W Church St
Ste C
Lexington, TN 38351
Phone (731) 968-2513
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 0000000152 | TN | Yes |
Addresses
Primary practice location
870 W Church St
Suite C
Lexington, TN 38351-1741
Mailing address
870 W Church St
Suite C
Lexington, TN 38351-1741
Phone (731) 968-2513
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 044 2661 | Medicaid | TN |
Other providers in Lexington, TN
- Shannon Leanne Davis
- Robert G Day
- Bobby L Deberry
- Delta Clinics, PLC
- Lisa Brooke Deneweth
- Diamond Transportation
- Deborah Dickinson
- Rebecca Jo Dinkins
- Karol L Disher
- Cathy Elizabeth Dorris
All providers in Lexington, TN · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 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.