| Organization Name: | SANDERLING RENAL SERVICES OF HOLDENVILLE |
| NPI Number: | 1124377460 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEREOME S TANNENBAUM (ADMINISTRATOR) |
| Mailing Address: | 102 Crestview St Holdenville |
| State: | OK US |
| Postal Code: | 748482844 |
| Phone Number: | 6154670140 |
| Fax Number: | |
| NPI Enumeration Date: | 08/31/2012 |
| NPI Last Update Date: | 10/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |