Healthcare Provider Details

I. General information

NPI: 1043835143
Provider Name (Legal Business Name): QITEK LABS OF OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 NW 63RD ST STE C
OKLAHOMA CITY OK
73116-2011
US

IV. Provider business mailing address

4375 RIVER GREEN PKWY STE 200
DULUTH GA
30096-8319
US

V. Phone/Fax

Practice location:
  • Phone: 888-857-4835
  • Fax: 470-645-9256
Mailing address:
  • Phone: 888-857-4835
  • Fax: 470-645-9256

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: ZACHARY HUSK
Title or Position: CEO
Credential:
Phone: 888-857-4835