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General NPI Number Information
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NPI Number | 1255514329
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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 | 12/12/2007
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 200 2ND AVE SW
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City | MIAMI
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State | OK
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Zip | 74354-6830
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Country | US
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Telephone | 918-542-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 14275 MIDWAY RD STE 400
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City | ADDISON
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State | TX
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Zip | 75001-3661
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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 | CEO
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Name | R'NEE MULLEN
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Credential |
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Telephone | 405-608-6290
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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 | 37D0667302
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License Number State | OK
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