Provider Demographics
NPI:1083715981
Name:DIALYSIS SPECIALISTS OF CENTRAL OKLAHOMA
Entity Type:Organization
Organization Name:DIALYSIS SPECIALISTS OF CENTRAL OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:I
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-942-5442
Mailing Address - Street 1:5510 N FRANCIS
Mailing Address - Street 2:
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73118
Mailing Address - Country:US
Mailing Address - Phone:405-858-0025
Mailing Address - Fax:405-858-0141
Practice Address - Street 1:3366 NW EXPRESSWAY
Practice Address - Street 2:SUITE 670
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-942-5442
Practice Address - Fax:405-942-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163WD1100XNursing Service ProvidersRegistered NurseDialysis, PeritonealGroup - Multi-Specialty
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Not Answered2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
372539Medicare ID - Type Unspecified
E11695Medicare UPIN