Healthcare Provider Details

I. General information

NPI: 1407609209
Provider Name (Legal Business Name): TOXCODE DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 S 122ND EAST AVE STE 202A
TULSA OK
74146-6025
US

IV. Provider business mailing address

5115 S 122ND EAST AVE STE 202A
TULSA OK
74146-6025
US

V. Phone/Fax

Practice location:
  • Phone: 918-856-3111
  • Fax: 918-515-7826
Mailing address:
  • Phone: 918-856-3111
  • 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: CRISSY WILLIAMS
Title or Position: OWNER
Credential:
Phone: 918-282-6577