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Shade Dialysis Llc
End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Wagoner, Oklahoma
NPI 1215483862

Shade Dialysis Llc is a End-Stage Renal Disease (ESRD) Treatment Clinic/Center based in Brentwood, OK and is specialized in End-Stage Renal Disease (ESRD) Treatment. Shade Dialysis Llc practices in Wagoner, OK. The NPI Number for Shade Dialysis Llc is 1215483862 and holds a License No. (Oklahoma).

The current practice location address for Shade Dialysis Llc is 402 South Wall Street, Wagoner, OK and can be reached out via phone at 918-485-4363 and via fax at 918-485-3043.

Location: 402 South Wall Street, Wagoner, OK, 37027-7569
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1215483862
Provider Name
Shade Dialysis Llc
Credential
Provider Entity Type
Organization
Address
402 South Wall Street, Wagoner, OK, 37027-7569
Phone Number
918-485-4363
Fax Number
918-485-3043
Provider Enumeration Date
09/01/2016
Last Update Date
10/19/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
200748420A 05 OK
institution
Provider Business Practice Location Address Details
Address
402 South Wall Street
City
Wagoner
State
Oklahoma
Zip
74467-5003
Phone Number
918-485-4363
Fax Number
918-485-3043
person
Provider Business Mailing Address Details
Address
402 South Wall Street
City
Wagoner
State
Oklahoma
Zip
74467-5003
Phone Number
918-485-4363
Fax Number
918-485-3043
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
End-Stage Renal Disease (ESRD) Treatment
Taxonomy
261QE0700X
License No.
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Definition
Definition to come...
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