COMANCHE NEPHROLOGY PC (NPI# 1689863946) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689863946 |
| Entity Type | Organization |
| Organization Name | COMANCHE NEPHROLOGY PC |
| Practice Address |
4417 W Gore Blvd Suite 1 Lawton OK 73505-5978 |
| Practice Telephone | 5805365273 |
| Mailing Telephone | 5805365273 |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2010-12-11 |
| Authorized Official Name | DR. BALI REDDY SODAM (PHYSICIAN) |
| Authorized Official Telephone | 5805365273 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
24723 | OK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200123460A | 05 |
| Street Address |
4417 W GORE BLVD SUITE 1 |
| City | LAWTON |
| State | OK |
| Zip Code | 73505-5978 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609879899 | Ross Hensley | Dermatology | 4417 W Gore Blvd, Ste 7, Lawton, OK 73505-5978 | 2005-05-23 |
| 1275935702 | Jacqueline Alford | Dentist | 4417 W Gore Blvd, Ste 11, Lawton, OK 73505-6019 | 2014-09-16 |
| 1932546389 | Christopher Alexander Larrow | Dentist | 4417 W Gore Blvd, Ste 11, Lawton, OK 73505-6019 | 2013-05-24 |
| 1518243096 | Magdalena B Sikora Md PC | Clinic/Center | 4417 W Gore Blvd, Suite 1, Lawton, OK 73505-5978 | 2011-10-27 |
| 1790916922 | Debra A Crawford, Do LLC | Obstetrics & Gynecology | 4417 W Gore Blvd, Ste 3, Lawton, OK 73505-5978 | 2009-08-05 |
| 1194858720 | Jeffrey L Zweig Md PC | Obstetrics & Gynecology | 4417 W Gore Blvd, Ste 3, Lawton, OK 73505-5978 | 2007-03-13 |
| 1598896110 | Magdalena Barbara Sikora | Internal Medicine | 4417 W Gore Blvd, Suite 1, Lawton, OK 73505-5978 | 2007-03-07 |
| 1568590784 | Dan Horton, M.d., Inc. | Clinic/Center | 4417 W Gore Blvd, Suite 6, Lawton, OK 73505-5978 | 2007-03-01 |
| 1457448698 | Wavel L. Wells, Dds, Inc | Dentist | 4417 W Gore Blvd, Suite 11, Lawton, OK 73505-5978 | 2006-10-09 |
| 1467551150 | Nicholas Joseph Chelenza Jr. | Dentist | 4417 W Gore Blvd, Suite 11, Lawton, OK 73505-5978 | 2006-09-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134744006 | Angela Janell Smith | Case Manager/Care Coordinator | 4904 Nw Smith Ave, Lawton, OK 73505 | 2020-06-16 |
| 1295383990 | Akeemia Lorene Holder | Case Manager/Care Coordinator | Youth Care of Oklahoma, 713 Sw C Avenue, OK 73505 | 2019-08-27 |
| 1225685480 | Healthstat Onsite Clinic Goodyear Vision Center | Preventive Medicine | 1 Goodyear Blvd, Lawton, OK 73505 | 2019-08-22 |
| 1891285300 | Michael Anthony Gray | Case Manager/Care Coordinator | 2218 Nw 36th St, Lawton, OK 73505 | 2018-05-10 |
| 1841797362 | Adeshola T Fatuyi | Case Manager/Care Coordinator | 7301 Sw Lee 635, Lawton, OK 73505 | 2018-04-11 |
| 1912425539 | Heather Shea Morefield | Case Manager/Care Coordinator | 2712 Sw H Ave, Lawton, OK 73505 | 2017-09-04 |
| 1972031367 | Burke Hendricks | Emergency Medicine | 3401 West Gore Boulevard, Lawton, OH 73505 | 2017-05-30 |
| 1932642279 | Helery Vance | Peer Specialist | 1420 Nw Hunter Rd Apt C7, Lawton, OK 73505 | 2016-11-18 |
| 1629523436 | Sebrina Sheppard | Case Manager/Care Coordinator | 3907 Sw Parkridge Blvd., Lawton, OK 73505 | 2016-08-22 |
| 1376913590 | David Lee Atauvich | Registered Nurse | 1515 Lawrie Rd, Lawton, OK 73505 | 2015-09-30 |
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| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720036122 | Suhas Damodar Agte | Internal Medicine | 5108 W Gore Blvd, Suite 2, Lawton, OK 73505-6025 | 2006-05-05 |
| 1043512049 | Freedom Ikedionwu, Md, PC | Internal Medicine | 1819 W Gore Blvd, Lawton, OK 73501-3614 | 2010-11-23 |
| 1649478447 | Suhas D Agte Md PC | Internal Medicine | 5108 W Gore Blvd, Suite2, Lawton, OK 73505-6025 | 2007-07-03 |
| 1598896110 | Magdalena Barbara Sikora | Internal Medicine | 4417 W Gore Blvd, Suite 1, Lawton, OK 73505-5978 | 2007-03-07 |
| 1689787780 | Bali Reddy Sodam | Internal Medicine | 4417 W Gore Blvd, Suite 1, Lawton, OK 73505-5978 | 2006-08-16 |
| 1740215235 | Lawton Nephrology | Internal Medicine | 5108 W Gore Blvd, Ste 2, Lawton, OK 73505-6025 | 2006-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710416573 | Universal Kidney Care of Oklahoma Pllc | Internal Medicine | 5300 N Independence Ave Ste 280, Oklahoma City, OK 73112-5555 | 2017-06-06 |
| 1801334982 | Jamie Lynne Miller | Internal Medicine | 2000 S. Wheeling Avenue Ste 510, Tulsa, OK 74104 | 2017-02-08 |
| 1710393160 | Narisorn Atsava-svate | Internal Medicine | 3400 Nw Expressway Ste 700, Oklahoma City, OK 73112-4492 | 2014-07-07 |
| 1730515362 | Fazal Akbar Ali Md PC | Internal Medicine | 4221 S Western Ave Ste 5020, Oklahoma City, OK 73109-3445 | 2013-09-14 |
| 1902193865 | Andres Rodrigo Caero Romero | Internal Medicine | 2611 Crossroads Dr, Ardmore, OK 73401-2574 | 2011-06-29 |
| 1972740389 | Oklahoma Hypertension and Kidney Center, Plcc | Internal Medicine | 10203 S Canton Ave, Tulsa, OK 74137-6059 | 2009-01-08 |
| 1609030345 | Ahmad Bilal | Internal Medicine | 3366 Nw Expressway #730, Bldg D, Oklahoma City, OK 73112 | 2008-07-11 |
| 1861676736 | Salah Uddin | Internal Medicine | 1923 E 21st St Ste 200, Tulsa, OK 74114-1447 | 2007-12-27 |
| 1932388360 | Robert Wallace King Jr. | Internal Medicine | 14508 Maplelake Dr, Edmond, OK 73013-1863 | 2007-11-02 |
| 1013040898 | Midwest Nephrology Associates PC | Internal Medicine | 1201 S Douglas Blvd Ste K, Midwest City, OK 73130-5263 | 2007-03-13 |
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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.