Healthcare Provider Details

I. General information

NPI: 1326903550
Provider Name (Legal Business Name): POE SCREENING & LABORATORY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 NE 35TH ST
MOORE OK
73160-2776
US

IV. Provider business mailing address

1608 NE 35TH ST
MOORE OK
73160-2776
US

V. Phone/Fax

Practice location:
  • Phone: 405-919-7484
  • Fax:
Mailing address:
  • Phone: 405-919-7484
  • 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: QUAQUETTA DE'SHEL POE
Title or Position: MANAGING MEMBER
Credential:
Phone: 405-919-7484