SHADE DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Wagoner, OK. SHADE DIALYSIS LLC NPI is 1215483862. The provider is registered as an organization entity type.
The provider Is Doing Business As Wagoner Dialysis.
The provider's business location address is:
402 SOUTH WALL STREET
WAGONER, OK
ZIP 74467-003
Phone: (918) 485-4363
Fax: (918) 485-3043
The provider's authorized official is Samuel Wey .
The authorized official title is Vp, Licensure & Certification and has the following contact phone number (615) 341-6641.
The CLIA number assigned to this NPI record is 37D2121594 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 9/1/2016 and was last updated on 3/27/2024.