Healthcare Provider Details

I. General information

NPI: 1154783074
Provider Name (Legal Business Name): ALPHA MEDICAL LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 09/02/2025
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 E 81ST ST STE 4000
TULSA OK
74137-4300
US

IV. Provider business mailing address

2448 E 81ST ST STE 4000
TULSA OK
74137-4300
US

V. Phone/Fax

Practice location:
  • Phone: 918-983-0944
  • Fax: 918-399-9098
Mailing address:
  • Phone: 918-398-0944
  • Fax: 918-939-9098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT E GATES
Title or Position: MANAGING MEMBER
Credential:
Phone: 918-949-5544