Platte Dialysis LLC

Primary specialty

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

Legal business name

PLATTE DIALYSIS LLC

Practice address

81143 Highway 59
Stilwell, OK 74960-1641

Phone

(918) 696-5072

Fax

(918) 696-5074

NPI assigned

Mar 4, 2013

Organization subpart

No

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

Authorized official

Name

Samuel T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Stilwell Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Platte Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Sallisaw, OK
  • NPI 1205177870

  4789725524

  Same PAC ID
• Platte Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Muskogee, OK
  • NPI 1598006041

  4789725524

  Same PAC ID
• Platte Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tahlequah, OK
  • NPI 1740515378

  4789725524

  Same PAC ID

Tax ID family

Platte Dialysis LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Platte Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Sallisaw, OK
  • NPI 1205177870
  NPD tax ID
• Platte Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Muskogee, OK
  • NPI 1598006041
  NPD tax ID
• Platte Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tahlequah, OK
  • NPI 1740515378
  NPD tax ID

Member of 2

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

• Northeastern Health System

  • Rehabilitation Hospital Unit
  • Tahlequah, OK
  • NPI 1528122371

  Member Of

  NPD member
• Renal Treatment Centers West Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Oklahoma City, OK
  • NPI 1124509245

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1362355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1972844884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4268",
            "fax_number": "877-238-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81143 HIGHWAY 59",
            "city": "STILWELL",
            "state": "OK",
            "postal_code": "749601641",
            "telephone_number": "918-696-5072",
            "fax_number": "918-696-5074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATTE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-04",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "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": "100733210G",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stilwell Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stilwell Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Peyok, D.O.
• Phoenix Counseling Services LLC
• Phoenix Rising Counseling Services
• Alex Pinkerton, PHARMACIST
• Mike B Pinkerton, DPH
• Susan Dawn Powers
• Claire Elise Presley, PARAPROFESSIONAL
• Professional Home Health Care Inc
• Jaclyn Rackley
• Leslie J Rebtoy, DO

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Stilwell, OK
• Providers in Stilwell, 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 11, 2024; 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.