ST. JOHN DIALYSIS, LLC (NPI# 1356429500) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356429500 |
| Entity Type | Organization |
| Organization Name | ST. JOHN DIALYSIS, LLC |
| Practice Address |
1515 N Harvard Ave Tulsa OK 74115-4957 |
| Mailing Address |
1923 S Utica Ave Tulsa OK 74104-6520 |
| Practice Telephone | 9188355599 |
| Mailing Telephone | 9187442345 |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-09-07 |
| Authorized Official Name | SR. M. THERESE GOTTSCHALK (PRESIDENT/CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 9187442180 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. JOHN MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
2265 | OK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | BCBS | 000370114003 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902984156 | St. John Dialysis, LLC | Clinic/Center | 1923 East 21st Street, Tulsa, OK 74114-1402 | 2006-11-02 |
| 1639255243 | St. John Dialysis, LLC | Clinic/Center | 1013 E Cleveland Ave, Sapulpa, OK 74066-4516 | 2006-10-27 |
| Street Address |
1515 N HARVARD AVE |
| City | TULSA |
| State | OK |
| Zip Code | 74115-4957 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043289721 | Hurlis Vondale Graham | Internal Medicine | 1515 N Harvard Ave, Ste E, Tulsa, OK 74115-4957 | 2006-03-16 |
| 1306287982 | Fresenius Medical Care Tulsa, LLC | Clinic/Center | 1515 N Harvard Ave, Suite D, Tulsa, OK 74115-4957 | 2013-07-11 |
| 1558383729 | Elizabeth Frost | Anesthesiology | 1515 N Harvard Ave, Suite E, Tulsa, OK 74115-4957 | 2006-07-24 |
| 1144249301 | Ann E Bartoloni | Anesthesiology | 1515 N Harvard Ave, Suite E, Tulsa, OK 74115-4957 | 2006-07-19 |
| 1902868599 | James Easley | Anesthesiology | 1515 N Harvard Ave, Suite E, Tulsa, OK 74115-4957 | 2006-04-06 |
| 1689636292 | Gregory Marino | Anesthesiology | 1515 N Harvard Ave, Suite E, Tulsa, OK 74115-4957 | 2006-04-06 |
| 1760445308 | Harold Stratton | Anesthesiology | 1515 N Harvard Ave, Suite E, Tulsa, OK 74115-4957 | 2006-04-06 |
| 1306808456 | Dan Lee Wiesemeyer | Anesthesiology | 1515 N Harvard Ave, Suite E, Tulsa, OK 74115-4957 | 2006-04-04 |
| 1053373167 | Darrell Heck | Anesthesiology | 1515 N Harvard Ave, Suite E, Tulsa, OK 74115-4957 | 2006-04-04 |
| 1154382828 | James Byran Wesson | Clinical Nurse Specialist | 1515 N Harvard Ave, Ste. E, Tulsa, OK 74115-4957 | 2006-03-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538698899 | Pateisha Royal | Counselor | 7813 E. Independence St., Tulsa, OK 74115 | 2017-06-08 |
| 1154788750 | Heather Sisson-white | Case Manager/Care Coordinator | 132 N. Marion Ave, Tulsa, OK 74115 | 2016-01-27 |
| 1427234004 | American Current Care P.a. | Clinic/Center | 1541 North Sheridan Road, Tulsa, OK 74115 | 2008-01-14 |
| 1205031317 | Veera Aparanji Kaja | Dentist | 6801 E. Admiral Place, Tulsa, OK 74115 | 2007-06-19 |
| 1922137926 | Gregory L Mitchell | Preventive Medicine | 1515 N Harvard, Suite B, Tulsa, OK 74115 | 2007-03-05 |
| 1215942602 | G Chris Bussman | Dentist | 6716 E Pine, Tulsa, OK 74115 | 2006-07-31 |
| 1205870912 | Board of Regents of The University of Oklahoma Ou Physicians Tulsa | Family Medicine | Bcchs Celia Clinton Elementary, 1740 N. Harvard Ave., Tulsa, OK 74115 | 2006-06-15 |
| 1356853832 | Phoenix Soleil-maria Cooper | Case Manager/Care Coordinator | 3641 E 36th St N, Tulsa, OK 74115-1702 | 2017-10-24 |
| 1215380449 | Taleya Mayberry | Case Manager/Care Coordinator | 4115 E 36th St N, Tulsa, OK 74115-1709 | 2016-07-23 |
| 1104925619 | Marsha Ann Basner | Nutritionist | 3324 E 30th Pl N, Tulsa, OK 74115-2421 | 2006-09-21 |
| Find all providers in zip 74115 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710539424 | Fresenius Medical Care Tulsa, LLC | Clinic/Center | 9310 East 91st Street, Tulsa, OK 74133 | 2019-07-12 |
| 1811401631 | Fresenius Medical Care Tulsa, LLC | Clinic/Center | 5230 S Mingo Rd, Tulsa, OK 74146 | 2017-12-01 |
| 1437590015 | Fresenius Medical Care Tulsa, LLC | Clinic/Center | 2845 E Skelly Dr, Tulsa, OK 74105-6221 | 2013-07-11 |
| 1548609480 | Fresenius Medical Care Tulsa, LLC | Clinic/Center | 8620 S. Lewis Ave., Tulsa, OK 74137-1267 | 2013-06-24 |
| 1487093720 | Fresenius Medical Care Tulsa, LLC | Clinic/Center | 2309 W Edison St, Suite A, Tulsa, OK 74127-5218 | 2013-06-20 |
| 1710140967 | Bio-medical Applications of Oklahoma, Inc. | Clinic/Center | 2309a W Edison St, Tulsa, OK 74127-5218 | 2008-07-08 |
| 1255509188 | Biomedical Application of Okla | Clinic/Center | 2309a West Edison, Tulsa, OK 74127-5218 | 2008-02-13 |
| 1902984156 | St. John Dialysis, LLC | Clinic/Center | 1923 East 21st Street, Tulsa, OK 74114-1402 | 2006-11-02 |
| 1528160710 | Dialysis Specialists of Tulsa, Inc. | Clinic/Center | 8260 S Lewis Ave, Tulsa, OK 74137-1267 | 2006-09-01 |
| 1700842655 | Greenwood Dialysis LLC | Clinic/Center | 1345 N Lansing Ave, Tulsa, OK 74106-5911 | 2006-04-20 |
| Find all providers in TULSA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.