Organization
SNG - SEMINOLE DIALYSIS CENTER LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KINAM C. MARTIN (CHIEF OPERATIONS OFFICER)
(817) 725-7900
Entity
Organization
Contact information
Practice address
12581 NS 3540, SEMINOLE, OK 74868-5879
(405) 382-9809
(405) 382-7911
Mailing address
1000 W CANNON ST, FORT WORTH, TX 76104-3029
(817) 725-7900
(682) 207-1030
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
—
200530820A
—
OK
Enumeration date
03/09/2011
Last updated
07/21/2022
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