Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southlake Dialysis LLC

Organization End-Stage Renal Disease (ESRD) Treatment Clinic/Center · NPI 1568708279

Southlake Dialysis LLC is an End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Broken Arrow, Oklahoma. Medicare rates this dialysis facility 3 out of 5. Registered with an NPI since 2012.

CMS rating
3 of 5
In the registry since
2012
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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CMS quality rating

3 out of 5 — official dialysis facility rating from CMS Care Compare (CCN 372516)

Practice location Address checks out

1710 N 9th St
Broken Arrow, OK 74012-8283
Phone: (918) 355-0657
Fax: (918) 355-2800
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

End-Stage Renal Disease (ESRD) Treatment Clinic/Center (primary) Taxonomy 261QE0700X

Record details

NPI number1568708279
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Samuel Wey — Vp Licensure & Certification · (615) 341-6641
Other names Broken Arrow Dialysis Center
NPI enumeratedDecember 27, 2012
Last updated in NPPESMay 1, 2025
Certification dateMay 1, 2025
Mailing address5200 Virginia Way, Attn: L&C Dept, Brentwood, TN 37027-7569

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