Healthcare Provider Details

I. General information

NPI: 1518145655
Provider Name (Legal Business Name): ORAL PATHOLOGY LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 HOLDREGE ST ROOM 100
LINCOLN NE
68583-0740
US

IV. Provider business mailing address

PO BOX 830740 40TH AND HOLDREGE ST
LINCOLN NE
68583-0740
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1296
  • Fax: 402-472-2551
Mailing address:
  • Phone: 402-472-1296
  • Fax: 402-472-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNE

VIII. Authorized Official

Name: DR. NAGAMANI NARAYANA
Title or Position: DIRECTOR
Credential: D.M.D., M.S.
Phone: 402-472-1355