Provider Demographics
NPI:1710214788
Name:FRESENIUS MEDICAL CARE CENTRAL OKLAHOMA CITY DIALYSIS CENTER, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE CENTRAL OKLAHOMA CITY DIALYSIS CENTER, LLC
Other - Org Name:FRESENIUS MEDICAL CARE NORTHWEST OKLAHOMA CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:3107 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5302
Mailing Address - Country:US
Mailing Address - Phone:405-949-0237
Mailing Address - Fax:405-948-5066
Practice Address - Street 1:3107 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5302
Practice Address - Country:US
Practice Address - Phone:405-949-0237
Practice Address - Fax:405-948-5066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-11
Last Update Date:2023-10-17
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
372540Medicare Oscar/Certification