ST. JOHN DIALYSIS, LLC (NPI# 1902984156) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902984156 |
| Entity Type | Organization |
| Organization Name | ST. JOHN DIALYSIS, LLC |
| Practice Address |
1923 East 21st Street Tulsa OK 74114-1402 |
| Mailing Address |
1923 S Utica Ave Tulsa OK 74104-6520 |
| Practice Telephone | 9187443535 |
| Mailing Telephone | 9187442345 |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2008-02-12 |
| 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 | 000370114002 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639255243 | St. John Dialysis, LLC | Clinic/Center | 1013 E Cleveland Ave, Sapulpa, OK 74066-4516 | 2006-10-27 |
| 1356429500 | St. John Dialysis, LLC | Clinic/Center | 1515 N Harvard Ave, Tulsa, OK 74115-4957 | 2006-11-02 |
| Street Address |
1923 EAST 21ST STREET |
| City | TULSA |
| State | OK |
| Zip Code | 74114-1402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356865307 | Helen Marie Collier | Registered Nurse | 2325 S. Harvard Avenue, Tulsa, OK 74114 | 2017-08-01 |
| 1730635640 | Portia Resnick | Specialist/Technologist | 5707 E 24th Pl, Tulsa, OK 74114 | 2016-08-31 |
| 1093177925 | Ana Achlosser | Counselor | 2120 S Jamestown Ave, Tulsa, OK 74114 | 2016-03-21 |
| 1437558277 | Nicole Holzkamper | Case Manager/Care Coordinator | 2525 S Harvard Ave, Tulsa, OK 74114 | 2014-08-18 |
| 1619216272 | Nicole Lisette Mancinelli | Physician Assistant | 2424 E. 21st Street, Suite 320, Tulsa, OK 74114 | 2013-02-01 |
| 1598001414 | Zachary Paschall | Counselor | 2325 S Havard Ave, Tulsa, OK 74114 | 2012-12-20 |
| 1346511334 | Chelsea Lee Joslin | Counselor | 2140 S Harvard Ave Ste 200, Tulsa, OK 74114 | 2012-01-23 |
| 1073893210 | Elizabeth C Canfield | Speech-Language Pathologist | 1929 South 74th East Avenue, Tulsa, OK 74114 | 2011-08-19 |
| 1508185430 | Karly Lynn Mason | Social Worker | 2140 S. Harvard, Tulsa, OK 74114 | 2010-05-17 |
| 1790922185 | State of Oklahoma | Community Based Residential Treatment Facility, Mental Illness | 2323 South Harvard, Tulsa, OK 74114 | 2009-01-07 |
| Find all providers in zip 74114 | ||||
| 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 |
| 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 |
| 1881657443 | Southcrest Dialysis LLC | Clinic/Center | 10921 E 81st St, Tulsa, OK 74133-4227 | 2006-04-06 |
| 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.