ST. JOHN DIALYSIS LLC NPI 1639255243

NPI Information

NPI: 1639255243
Provider Name: ST. JOHN DIALYSIS, LLC
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 37D0473397

Address:
1013 E CLEVELAND AVE
SAPULPA, OK
ZIP 74066
Phone: (918) 227-3351
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ST. JOHN DIALYSIS, LLC is an end-stage renal disease (esrd) treatment clinic center in Sapulpa, OK. ST. JOHN DIALYSIS, LLC NPI is 1639255243. The provider is registered as an organization entity type.

The provider's business location address is:

1013 E CLEVELAND AVE
SAPULPA, OK
ZIP 74066-516
Phone: (918) 227-3351

The provider's authorized official is Sr. M. Therese Gottschalk .
The authorized official title is President/chief Executive Officer and has the following contact phone number (918) 744-2180.

The CLIA number assigned to this NPI record is 37D0473397 - hospital with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/27/2006 and was last updated on 9/7/2007.

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	2265	OKLAHOMA	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	000370114001	OTHER	OKLAHOMA	BCBS
2	373509	MEDICARE OSCAR/CERTIFICATION	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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