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General NPI Number Information
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NPI Number | 1043963630
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Entity Type | Organization
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Legal Business Name | SOUTHERN PLAINS LABORATORIES LLC
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 2222 W IOWA AVE
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City | CHICKASHA
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State | OK
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Zip | 73018-2738
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Country | US
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Telephone | 800-889-3000
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Fax | 405-561-1008
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Provider Business Mailing Address
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Address Line | 2222 W IOWA AVE
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City | CHICKASHA
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State | OK
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Zip | 73018-2738
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Country | US
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Telephone | 800-889-3000
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Fax | 405-561-1008
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. SWAPNIL RADADIA
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Credential |
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Telephone | 469-660-6155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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