Dialysis Clinic Inc
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Fairfield, ME
NPI 1902228513 · NPPES record last updated Oct 5, 2023
Key facts
- NPI
- 1902228513
- 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
- 205 Ridge Rd
Fairfield, ME 04937-3376 - Phone
- (207) 238-9321
- Fax
- (207) 238-9456
- NPI assigned
- Jan 16, 2014
- Organization subpart
- No
Authorized official
- Name
- Donovan Schultz
- Title
- President
- Phone
- (615) 327-3061
Corporate family (same tax ID) 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
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 |
|---|---|---|---|---|
| O20140217000360 | ME | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 4284541129 | Practice locations: Fairfield, ME |
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
205 Ridge Rd
Fairfield, ME 04937-3376
Mailing address
149 North St
MGMC - Thayer Campus - Dialysis
Waterville, ME 04901-4974
Phone (207) 872-1291
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902228513 | Medicaid | ME |
Other providers in Fairfield, ME
- Michael E Clark
- Robert Colby
- Christine Custer
- Hannah Dangler
- John Delgiudice
- Debra Ann Doody
- Leah E Dostie
- Amanda Elizabeth Douglass
- James Earl Dunlap
- Alissa Eileen Dunn
All providers in Fairfield, ME · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maine
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.