JACINTO DIALYSIS LLC NPI 1457697575

NPI Information

NPI: 1457697575
Provider Name: JACINTO DIALYSIS LLC

Doing Business As: ARDMORE DIALYSIS RANCH

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
2617 CROSSROADS DR
ARDMORE, OK
ZIP 73401
Phone: (580) 490-9844
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JACINTO DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Ardmore, OK. JACINTO DIALYSIS LLC NPI is 1457697575. The provider is registered as an organization entity type.
The provider Is Doing Business As Ardmore Dialysis Ranch.

The provider's business location address is:

2617 CROSSROADS DR
ARDMORE, OK
ZIP 73401-574
Phone: (580) 490-9844
Fax: (580) 490-9831

The provider's authorized official is Samuel Wey .
The authorized official title is Vp, Licensure & Certification and has the following contact phone number (615) 341-6641.

The enumeration date for this NPI number is 12/18/2012 and was last updated on 11/28/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200519620A	MEDICAID	OKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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