Organization
JACINTO DIALYSIS LLC
Active
Other names
Ardmore Dialysis Ranch
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2617 CROSSROADS DR, ARDMORE, OK 73401-2574
(580) 490-9844
(580) 490-9831
Mailing address
5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200519620A
—
OK
Enumeration date
12/18/2012
Last updated
07/17/2025
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