St. John Dialysis, LLC

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

1013 E Cleveland Ave
Sapulpa, OK 74066-4516

Phone

(918) 227-3351

NPI assigned

Oct 27, 2006

Organization subpart

Yes

Parent organization

ST. JOHN MEDICAL CENTERAs reported in NPPES

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

Addresses

Other identifiers 1

Part of

St Johns Hospital

Member of 1

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

• St John Medical Center Inc

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1154417368

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189123200000",
    "number": "1639255243",
    "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": "1013 E CLEVELAND AVE",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740664516",
            "telephone_number": "918-227-3351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN DIALYSIS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. JOHN MEDICAL CENTER",
        "enumeration_date": "2006-10-27",
        "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": "000370114001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Springman
• St John Sapulpa
• St John Sapulpa
• St John Sapulpa, Inc
• St John Sapulpa, Inc.
• Peter Brice Stabnick, B.S.
• Brett E Stallings, D.D.S.
• Brian Stamile
• Kendra Stanaland, PT
• Michale Stanley

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Sapulpa, OK
• Providers in Sapulpa, 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 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.