Provider Demographics
NPI:1124377460
Name:SANDERLING RENAL SERVICES OF HOLDENVILLE
Entity Type:Organization
Organization Name:SANDERLING RENAL SERVICES OF HOLDENVILLE
Other - Org Name:SANDERLING DIALYSIS CENTER OF HOLDENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREOME
Authorized Official - Middle Name:S
Authorized Official - Last Name:TANNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:615-467-0140
Mailing Address - Street 1:PO BOX 198813
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-8813
Mailing Address - Country:US
Mailing Address - Phone:615-467-0140
Mailing Address - Fax:615-259-0693
Practice Address - Street 1:102 CRESTVIEW ST
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-2844
Practice Address - Country:US
Practice Address - Phone:615-467-0140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment