Healthcare Provider Details

I. General information

NPI: 1275367625
Provider Name (Legal Business Name): EXO BIOLOGICS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 S 167TH EAST PL
TULSA OK
74134-7133
US

IV. Provider business mailing address

4722 S 167TH EAST PL
TULSA OK
74134-7133
US

V. Phone/Fax

Practice location:
  • Phone: 405-919-9187
  • Fax:
Mailing address:
  • Phone: 405-919-9187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code331L00000X
TaxonomyBlood Bank
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL LEE BAST
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 405-919-9187