Organization
LAWTON DIALYSIS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BALI REDDY SODAM (OWNER)
(580) 536-5273
Entity
Organization
Contact information
Practice address
5110 W GORE BLVD, LAWTON, OK 73505-5909
(580) 248-3733
(580) 248-3993
Mailing address
5110 W GORE BLVD, LAWTON, OK 73505-5909
(580) 248-3733
(580) 248-3993
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
—
200752990A
—
OK
Enumeration date
10/11/2017
Last updated
01/12/2023
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