Provider Demographics
NPI:1669793915
Name:FRESENIUS MEDICAL CARE SOUTHEAST OKLAHOMA CITY, LLC
Entity type:Organization
Organization Name:FRESENIUS MEDICAL CARE SOUTHEAST OKLAHOMA CITY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-688-9000
Mailing Address - Street 1:810 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7215
Mailing Address - Country:US
Mailing Address - Phone:405-272-1553
Mailing Address - Fax:405-272-0506
Practice Address - Street 1:810 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7215
Practice Address - Country:US
Practice Address - Phone:405-272-1553
Practice Address - Fax:405-272-0506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-21
Last Update Date:2024-11-06
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
372532Medicare Oscar/Certification