Lawton Dialysis Center-East LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

LAWTON DIALYSIS CENTER-EAST LLC

Practice address

4516 SE Lee Blvd
Lawton, OK 73501-6558

Phone

(580) 351-1430

Fax

(580) 351-9980

NPI assigned

Oct 11, 2017

Organization subpart

No

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

Authorized official

Name

Bali Reddy SodamNPI 1689787780

Title

Owner

Phone

(580) 536-5273

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bali Reddy Sodam, MD

  • Nephrology Physician
  • Lawton, OK
  • NPI 1689787780
  NPD Authorized official

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

{
    "created_epoch": "1507680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1376053892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4516 SE LEE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735016558",
            "telephone_number": "580-351-1430",
            "fax_number": "580-351-9980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4516 SE LEE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735016558",
            "telephone_number": "580-351-1430",
            "fax_number": "580-351-9980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWTON DIALYSIS CENTER-EAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-11",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "SODAM",
        "authorized_official_first_name": "BALI",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-536-5273"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200753010A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lawton Chiropractic, PLLC
• Lawton CT and MRI, LLC
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• Lawton Dialysis Center LLC
• Lawton Dialysis, Inc. (RCG Lawton East)
• Lawton Dialysis, Inc. (Lawton Dialysis)
• Lawton Emergency Group LLC
• Lawton EMS Services, Inc.
• Lawton Endodontics

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Lawton, OK
• Providers in Lawton, OK by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.