Provider Demographics
NPI:1639776222
Name:PHYSICIANS CHOICE DIALYSIS OF MIDWEST CITY LLC
Entity Type:Organization
Organization Name:PHYSICIANS CHOICE DIALYSIS OF MIDWEST CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-290-7408
Mailing Address - Street 1:211 COMMERCE CT STE 104
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3483
Mailing Address - Country:US
Mailing Address - Phone:302-290-7408
Mailing Address - Fax:610-495-8652
Practice Address - Street 1:3200 SE 29TH STREET
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115
Practice Address - Country:US
Practice Address - Phone:610-495-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty