NPIMap

Organization Active NPI

St. John Dialysis, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tulsa, OK
National Provider Identifier
1356429500
Registry record updated Sep 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
2265 Issued in OK
Legal business name
ST. JOHN DIALYSIS, LLC
Practice address
1515 N Harvard Ave
Tulsa, OK 74115-4957
Phone
(918) 835-5599
NPI assigned
Nov 2, 2006
Last updated
Sep 7, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. JOHN MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sr. M. Therese Gottschalk
Title
President/Chief Executive Officer
Phone
(918) 744-2180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 2265 OK Primary

Addresses

Primary practice location

1515 N Harvard Ave
Tulsa, OK 74115-4957

Mailing address

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (918) 744-2345

Other identifiers 1

IdentifierTypeStateIssuer
000370114003OtherOKBCBS

National Provider Directory

National Provider Directory
Tax ID family
Saint Johns Hospital7 organizations share this tax ID, including this one
Part of
Saint Johns Hospital

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189123200000",
    "number": "1356429500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741046520",
            "telephone_number": "918-744-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 N HARVARD AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741154957",
            "telephone_number": "918-835-5599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN DIALYSIS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. JOHN MEDICAL CENTER",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-09-07",
        "status": "A",
        "authorized_official_last_name": "GOTTSCHALK",
        "authorized_official_first_name": "SR. M. THERESE",
        "authorized_official_title_or_position": "PRESIDENT/CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "918-744-2180"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "OK",
            "license": "2265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000370114003",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.