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General NPI Number Information
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NPI Number | 1043820111
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Entity Type | Organization
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Legal Business Name | MIDTOWN HOME DIALYSIS LLC
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 3727 NW 63RD ST STE 320
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-1931
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Country | US
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Telephone | 405-286-0391
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Fax | 405-767-6741
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Provider Business Mailing Address
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Address Line | 3727 NW 63RD ST STE 320
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-1931
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Country | US
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Telephone | 405-286-0391
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Fax | 405-767-6741
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Authorized Official
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Title or Position | MANAGER MEMBER
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Name | LESLIE A WHILES
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Credential |
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Telephone | 580-695-1306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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