Organization
STOCKTON DIALYSIS LLC
Active
Other names
Moore Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
620 S SANTA FE AVE STE C, MOORE, OK 73160-2476
(405) 799-2439
(405) 799-2409
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
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
—
200694610A
—
OK
Enumeration date
12/17/2014
Last updated
01/22/2024
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