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General NPI Number Information
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NPI Number | 1104922558
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Entity Type | Organization
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Legal Business Name | MCALESTER REGIONAL DIALYSIS CENTER, LLC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2 E CLARK BASS BLVD SUITE 101
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City | MCALESTER
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State | OK
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Zip | 74501-4210
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Country | US
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Telephone | 918-421-8373
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Fax | 918-421-8668
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Provider Business Mailing Address
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Address Line | 2 E CLARK BASS BLVD SUITE 101
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City | MCALESTER
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State | OK
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Zip | 74501-4210
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Country | US
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Telephone | 918-421-8373
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Fax | 918-421-8668
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Authorized Official
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Title or Position | NURSE MANAGER
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Name | BEVERLY G SWADLEY
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Credential | RN
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Telephone | 918-421-8373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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