Broken Arrow Dialysis Center

LBN: Southlake Dialysis Llc
Broken Arrow Dialysis Center is an health care organization with primary practice located at 1710 N 9Th St , Broken Arrow OK 74012-8283. The organization recently has only one registered license in Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment, which is considered as the primary health care specialty. Southlake Dialysis Llc can be contacted via phone (918) 355-0657, or through Wey, Samuel via phone (615) 341-6641.

Contact Information

Primary practice address
1710 N 9Th St Broken Arrow OK 74012-8283
Phone: (918) 355-0657
Fax: (918) 355-2800
Website:
Map and Directions
Authorized official contact:
Name: Wey, Samuel
Phone: (615) 341-6641

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment 261QE0700X

Profile Details

NPI number 1568708279
LBN Legal business name Southlake Dialysis Llc
DBA Doing business as Broken Arrow Dialysis Center
Authorized official Wey, Samuel
Entity Organization
Organization subpart 1 No
Enumeration date Dec 27th, 2012
Last updated Nov 8th, 2023 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568708279 NPPES
Oklahoma MEDICAID 200509720A

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