Healthcare Provider Details

I. General information

NPI: 1801131248
Provider Name (Legal Business Name): APSP-UPTOWN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PKWY STE 230
DALLAS TX
75234-7841
US

IV. Provider business mailing address

2410 W MEMORIAL RD STE C432
OKLAHOMA CITY OK
73134-8047
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-2732
  • Fax: 866-953-9990
Mailing address:
  • Phone: 405-285-2732
  • Fax: 866-953-9990

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: ERNEWST DIAZ
Title or Position: CEO
Credential:
Phone: 405-285-2732