Provider Demographics
NPI:1518034032
Name:DIALYSIS SPECIALISTS OF SEMINOLE OKLAHOMA, LLC
Entity Type:Organization
Organization Name:DIALYSIS SPECIALISTS OF SEMINOLE OKLAHOMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-382-9809
Mailing Address - Street 1:12581 NS 3540 CR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-9789
Mailing Address - Country:US
Mailing Address - Phone:405-382-9809
Mailing Address - Fax:405-382-7911
Practice Address - Street 1:12581 NS 3540 CR
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-9789
Practice Address - Country:US
Practice Address - Phone:405-382-9809
Practice Address - Fax:405-382-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2000129908Medicaid
E32187Medicare UPIN
OK2000129908Medicaid