Healthcare Provider Details

I. General information

NPI: 1093644098
Provider Name (Legal Business Name): PRIME MEDLAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15112 TRADITIONS BLVD
EDMOND OK
73013-1182
US

IV. Provider business mailing address

15112 TRADITIONS BLVD
EDMOND OK
73013-1182
US

V. Phone/Fax

Practice location:
  • Phone: 918-417-0878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER C FISHER
Title or Position: FOUNDER
Credential: MD
Phone: 918-417-0878