Healthcare Provider Details

I. General information

NPI: 1306940689
Provider Name (Legal Business Name): ANATOMICAL PATHOLOGY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N MONTE VISTA ST
ADA OK
74820-4609
US

IV. Provider business mailing address

421 N MONTE VISTA ST
ADA OK
74820-4609
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-9595
  • Fax: 580-332-4921
Mailing address:
  • Phone: 580-332-9595
  • Fax: 580-332-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number8286
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN WESLEY MOORING
Title or Position: OWNER
Credential: M. D.
Phone: 580-332-9595