NPIMap

Organization Active NPI

Comanche Nephrology PC

  • Nephrology Physician
  • Lawton, OK
National Provider Identifier
1689863946
Registry record updated Dec 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
24723 Issued in OK
Legal business name
COMANCHE NEPHROLOGY PC
Practice address
4417 W Gore Blvd
Suite 1
Lawton, OK 73505-5978
Phone
(580) 536-5273
NPI assigned
Oct 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2010

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

Authorized official

Name
Dr. Bali Reddy Sodam, M.D.NPI 1689787780
Title
Physician
Phone
(580) 536-5273

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 24723 OK Primary

Addresses

Primary practice location

4417 W Gore Blvd
Suite 1
Lawton, OK 73505-5978

Mailing address

4417 W Gore Blvd
Suite 1
Lawton, OK 73505-5978
Phone (580) 536-5273

Other identifiers 1

IdentifierTypeStateIssuer
200123460AMedicaidOK

National Provider Directory

National Provider Directory

Locations

4417 W Gore Blvd
Ste 1
Lawton, OK 73505
Phone (580) 536-5273

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292025600000",
    "number": "1689863946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4417 W GORE BLVD",
            "address_2": "SUITE 1",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735055978",
            "telephone_number": "580-536-5273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4417 W GORE BLVD",
            "address_2": "SUITE 1",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735055978",
            "telephone_number": "580-536-5273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMANCHE NEPHROLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-23",
        "last_updated": "2010-12-11",
        "status": "A",
        "authorized_official_last_name": "SODAM",
        "authorized_official_first_name": "BALI",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "580-536-5273",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "OK",
            "license": "24723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200123460A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2010; 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.