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General NPI Number Information
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NPI Number | 1093644098
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Entity Type | Organization
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Legal Business Name | PRIME MEDLAB LLC
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Dates
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Enumeration Date | 05/15/2026
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Last Update Date | 05/15/2026
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Provider Practice Location Address
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Address Line | 15112 TRADITIONS BLVD
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City | EDMOND
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State | OK
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Zip | 73013-1182
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Country | US
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Telephone | 918-417-0878
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Fax |
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Provider Business Mailing Address
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Address Line | 15112 TRADITIONS BLVD
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City | EDMOND
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State | OK
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Zip | 73013-1182
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | CHRISTOPHER C FISHER
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Credential | MD
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Telephone | 918-417-0878
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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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