Organization
ST. JOHN DIALYSIS, LLC
Active
Parent organization
ST. JOHN MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. JOHN MEDICAL CENTER
Authorized official
SR. M. THERESE GOTTSCHALK (PRESIDENT/CHIEF EXECUTIVE OFFICER)
(918) 744-2180
Entity
Organization
Contact information
Practice address
1923 EAST 21ST STREET, TULSA, OK 74114-1402
(918) 744-3535
Mailing address
1923 S UTICA AVE, TULSA, OK 74104-6520
(918) 744-2345
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
2265
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000370114002
BCBS
OK
Enumeration date
11/02/2006
Last updated
02/12/2008
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