Organization · Type 2 NPI

Jacinto Dialysis LLC

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Ardmore, OK

NPI number 1457697575 Active

Practice location

2617 Crossroads Dr
Ardmore, OK 73401-2574

Call (580) 490-9844 Map

Fax (580) 490-9831

Mailing address

5200 Virginia Way, L&c Department
Brentwood, TN 37027-7569

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	None listed

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

Another provider at this address

Ardmore Dialysis Ranch, IncEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center Ardmore, OK NPI 1992037626

Other end-stage renal disease (esrd) treatment clinic/center providers in Ardmore

See all in Ardmore →

NPI record

NPI: 1457697575
Entity type: Organization (Type 2)
Issued: Dec 18, 2012
Last updated: Jul 17, 2025
Status: Active

Other names

<unavail>
Ardmore Dialysis Ranch · doing business as
Ardmore Dialysis Ranch · doing business as

Authorized official

Samuel Wey
VP, Licensure & Certification
(615) 341-6641

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1457697575

Jacinto Dialysis LLC's National Provider Identifier is 1457697575, issued on Dec 18, 2012. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Ardmore, OK. The record was last updated on Jul 17, 2025.