Healthcare Provider Details

I. General information

NPI: 1982001137
Provider Name (Legal Business Name): PBHC LABORATORIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 SW H AVE STE 6
LAWTON OK
73505-8103
US

IV. Provider business mailing address

2305 SW H AVE STE 6
LAWTON OK
73505-8103
US

V. Phone/Fax

Practice location:
  • Phone: 580-699-8551
  • Fax: 580-699-8553
Mailing address:
  • Phone: 580-699-8551
  • Fax: 580-699-8553

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: DEWELL BREWER
Title or Position: CEO
Credential:
Phone: 580-699-8551