Provider Demographics
NPI:1407803380
Name:OKLAHOMA NEPHROLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:OKLAHOMA NEPHROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-951-4944
Mailing Address - Street 1:3366 NW EXPRESSWAY BLDG D
Mailing Address - Street 2:SUITE 730
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4462
Mailing Address - Country:US
Mailing Address - Phone:405-951-4944
Mailing Address - Fax:405-951-4955
Practice Address - Street 1:3366 NW EXPRESSWAY BLDG D
Practice Address - Street 2:SUITE 730
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4462
Practice Address - Country:US
Practice Address - Phone:405-951-4944
Practice Address - Fax:405-951-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100730540Medicaid
OK100730540Medicaid