Provider Demographics
NPI:1134333867
Name:NORMAN NEPHROLOGY, P.L.L.C.
Entity type:Organization
Organization Name:NORMAN NEPHROLOGY, P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSWALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LLANDEROSOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-329-3830
Mailing Address - Street 1:1561 N PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6621
Mailing Address - Country:US
Mailing Address - Phone:405-329-3830
Mailing Address - Fax:405-329-3791
Practice Address - Street 1:1561 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6621
Practice Address - Country:US
Practice Address - Phone:405-329-3830
Practice Address - Fax:405-329-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2010-02-05
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
OK200006110AMedicaid
372562Medicare ID - Type Unspecified