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General NPI Number Information
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NPI Number | 1215049747
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC LABORATORY OF OKLAHOMA LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 900 N PORTER AVE STE 109
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City | NORMAN
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State | OK
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Zip | 73071-6426
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Country | US
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Telephone | 405-329-5467
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 S COLLEGEVILLE RD
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2998
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Country | US
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Telephone | 866-697-8378
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Fax |
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Authorized Official
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Title or Position | CONTROLLER
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Name | LEO SELL
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Credential |
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Telephone | 405-608-6298
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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 | 37D0656554
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License Number State | OK
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