Healthcare Provider Details

I. General information

NPI: 1598123697
Provider Name (Legal Business Name): TOXICOLOGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 W MEMORIAL RD
OKLAHOMA CITY OK
73134-1512
US

IV. Provider business mailing address

3705 W MEMORIAL RD
OKLAHOMA CITY OK
73134-1512
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-9600
  • Fax:
Mailing address:
  • Phone: 405-752-9600
  • 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: STEPHEN B KELLY
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 405-752-9600