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SOUTHLAKE DIALYSIS LLC
NPI 1568708279
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Broken Arrow, OK

Active since December 27, 2012
1710 N 9TH ST, BROKEN ARROW, OK 74012(918) 355-0657(918) 355-2800 Get Directions Write a Review

NPPES record last updated: May 1, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 8, 2023, Oct 24, 2023, Oct 21, 2022 and 3 more (6 updates tracked since 2018).

About Southlake Dialysis Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHLAKE DIALYSIS LLC (NPI 1568708279), doing business as Broken Arrow Dialysis Center, is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Broken Arrow, Oklahoma and active in the NPI registry since December 2012. The organization lists Samuel Wey, Vp Licensure & Certification, as its authorized official.

NPPES Registry Identity

NPI1568708279
Entity TypeOrganization
Primary Taxonomy261QE0700X
Legal Business NameSOUTHLAKE DIALYSIS LLC
Location Address1710 N 9TH STBroken Arrow, OK 74012-8283
Mailing Address5200 Virginia Way, Attn: L&c DeptBrentwood, TN 37027-7569
Phone(918) 355-0657
Fax(918) 355-2800
Organization SubpartNo
Authorized OfficialSamuel WeyVp Licensure & Certification · (615) 341-6641
Enumeration DateDecember 27, 2012
Last NPPES UpdateMay 1, 20256 updates tracked since enumeration
NPPES CertifiedMay 1, 2025
✔ NPI 1568708279 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities
Taxonomy Code261QE0700X
1710 N 9TH ST, Broken Arrow, OK 74012
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Other Names 1

Doing Business AsBroken Arrow Dialysis Center

Other Identifiers 1

Medicaid200509720AOK

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.Insurance ›

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RENAL TREATMENT CENTERS WEST INC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1710 N 9TH ST
BROKEN ARROW, OK 74012
Tulsa County (918) 355-0657

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southlake Dialysis LLC's NPI number?

The NPI number for Southlake Dialysis LLC is 1568708279. It was assigned to this organization in the NPPES registry on December 27, 2012. The provider is doing business as Broken Arrow Dialysis Center.

Where is Southlake Dialysis LLC located?

Southlake Dialysis LLC is located at 1710 N 9th St, Broken Arrow, OK 74012. The listed phone number is (918) 355-0657.

What is Southlake Dialysis LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

What insurance does Southlake Dialysis LLC accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 9 other insurers list Southlake Dialysis LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southlake Dialysis LLC was last updated on May 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.