Healthcare Provider Details

I. General information

NPI: 1114101730
Provider Name (Legal Business Name): DIAGNOSTIC LABORATORY OF OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W WRANGLER BLVD
SEMINOLE OK
74868-1917
US

IV. Provider business mailing address

2750 MONROE BLVD
EAGLEVILLE PA
19403-2429
US

V. Phone/Fax

Practice location:
  • Phone: 405-303-4000
  • Fax:
Mailing address:
  • Phone: 484-676-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: G SCOTT CARTIER
Title or Position: VP NATIONAL BILLING
Credential:
Phone: 484-676-7331