Provider Demographics
NPI:1043820111
Name:MIDTOWN HOME DIALYSIS LLC
Entity Type:Organization
Organization Name:MIDTOWN HOME DIALYSIS LLC
Other - Org Name:NEW DIRECTION HOME DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-695-1306
Mailing Address - Street 1:3727 NW 63RD ST STE 320
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1931
Mailing Address - Country:US
Mailing Address - Phone:405-286-0391
Mailing Address - Fax:405-767-6741
Practice Address - Street 1:3727 NW 63RD ST STE 320
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1931
Practice Address - Country:US
Practice Address - Phone:405-286-0391
Practice Address - Fax:405-767-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment