Provider Demographics
NPI:1083651806
Name:NRA ADA OKLAHOMA LLC
Entity Type:Organization
Organization Name:NRA ADA OKLAHOMA LLC
Other - Org Name:ADA DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:324 NW J A RICHARDSON LOOP
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2017
Mailing Address - Country:US
Mailing Address - Phone:580-421-9131
Mailing Address - Fax:580-421-9135
Practice Address - Street 1:324 NW J.A. RICHARDSON LOOP
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2017
Practice Address - Country:US
Practice Address - Phone:580-421-9131
Practice Address - Fax:580-421-9135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKN/A261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200100430AMedicaid
OK37D1049560OtherCLIA CERTIFICATE OF WAIVE
OK37D1049560OtherCLIA CERTIFICATE OF WAIVE