Healthcare Provider Details

I. General information

NPI: 1285976811
Provider Name (Legal Business Name): APSP-FT STOCKTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 W IH 10
FORT STOCKTON TX
79735-2700
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 866-963-8889
  • Fax: 866-953-9990
Mailing address:
  • Phone: 866-963-8889
  • 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: ERNEST DIAZ
Title or Position: CEO
Credential:
Phone: 866-963-8889