Provider Demographics
NPI:1104922558
Name:MCALESTER REGIONAL DIALYSIS CENTER, LLC
Entity type:Organization
Organization Name:MCALESTER REGIONAL DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SWADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-421-8373
Mailing Address - Street 1:2 E CLARK BASS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4210
Mailing Address - Country:US
Mailing Address - Phone:918-421-8373
Mailing Address - Fax:918-421-8668
Practice Address - Street 1:2 E CLARK BASS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4210
Practice Address - Country:US
Practice Address - Phone:918-421-8373
Practice Address - Fax:918-421-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
372564Medicare ID - Type Unspecified