MEDICARE: LAWTON DIALYSIS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922518448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWTON DIALYSIS CENTER LLC

Provider Business Mailing Address
First Line	:	5110 W GORE BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5909
Country	:	US
Telephone Number	:	580-248-3733
Fax Number	:	580-248-3993

Provider Business Practice Location Address
First Line	:	5110 W GORE BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5909
Country	:	US
Telephone Number	:	580-248-3733
Fax Number	:	580-248-3993

Authorized Official
Title or Position	:	OWNER
Name	:	BALI REDDY SODAM
Credential	:
Telephone Number	:	580-536-5273

Provider Enumeration Date	:	10/11/2017
Last Update Date	:	01/12/2023

Similar Medicare Providers

1285637017 — SOUTHWEST IMAGING CENTER INC
Practice Location Address:

5116 W GORE BLVD , STE 1
LAWTON, OK
73505-5909

Practice Phone: 580-353-7226
Practice Fax: 580-353-7297

1033188743 — MS. BANDY JO RACKLEY RD, LD
Practice Location Address:

5110 W GORE BLVD
LAWTON, OK
73505-5909

Practice Phone: 580-713-3123
Practice Fax:

1922110899 — LAWTON DIALYSIS, INC.
Practice Location Address:

5110 W GORE BLVD , SUITE 1
LAWTON, OK
73505-5909

Practice Phone: 580-248-3733
Practice Fax:

1578894747 — SHEA FAMILY MEDICINE
Practice Location Address:

5112 W GORE BLVD STE 1
LAWTON, OK
73505-5909

Practice Phone: 580-699-3900
Practice Fax: 580-699-3901

1255204525 — KAYLEY LEBLANC FNP-C
Practice Location Address:

5404 SW LEE BLVD
LAWTON, OK
73505-9521

Practice Phone: 580-355-5242
Practice Fax: 580-355-5245

1497165328 — MS. JACQUELYN DENISE HUTCHENS LCSW
Practice Location Address:

8866 SW SUN VALLEY DR
LAWTON, OK
73505-5059

Practice Phone: 706-951-6786
Practice Fax:

Directions to “LAWTON DIALYSIS CENTER LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.