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NPI Code Detail

MEDICARE: BLACK HAWK LABS LLC

MEDICARE: BLACK HAWK LABS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1356087332
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLACK HAWK LABS LLC
Provider Business Mailing Address
First Line : 6312 E 101ST ST
Second Line :
City : TULSA
State : OK
Zip : 74137-7007
Country : US
Telephone Number : 918-512-1559
Fax Number :
Provider Business Practice Location Address
First Line : 6312 E 101ST ST
Second Line :
City : TULSA
State : OK
Zip : 74137-7007
Country : US
Telephone Number : 918-986-7118
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CHRISTINA FERGUSON
Credential :
Telephone Number : 918-986-7118
Provider Enumeration Date : 05/11/2022
Last Update Date : 09/16/2022

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Directions to “BLACK HAWK LABS LLC ” Practice Location

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