Organization
WHITE EAGLE DIALYSIS CENTER
Active
Parent organization
PONCA TRIBE OF OKLAHOMA
Organization subpart
Yes
Provider details
NPI number
Legal business name
PONCA TRIBE OF OKLAHOMA
Authorized official
MR. JOSEPH BLAN RN (DIALYSIS DIRECTOR)
(580) 765-2501
Entity
Organization
Contact information
Practice address
200 WHITE EAGLE DR, PONCA CITY, OK 74601-8315
(580) 765-2501
(580) 765-6348
Mailing address
200 WHITE EAGLE DR, PONCA CITY, OK 74601-8315
(580) 765-2501
(580) 765-6348
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
07/14/2016
Last updated
07/14/2016
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