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General NPI Number Information
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NPI Number | 1336556745
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Entity Type | Organization
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Legal Business Name | CERTIGEN LABORATORY, LLC
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 9309 S TOLEDO AVE SUITE A
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City | TULSA
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State | OK
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Zip | 74137-2752
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Country | US
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Telephone | 918-960-3150
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Fax | 918-960-3154
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Provider Business Mailing Address
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Address Line | PO BOX 649210
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City | DALLAS
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State | TX
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Zip | 75264-9210
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Country | US
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Telephone | 918-960-3150
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Fax | 918-960-3154
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | KIMBERLY KAY KIMREY
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Credential | MT(ASCP)
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Telephone | 918-960-3150
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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 | 37D2075661
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License Number State | OK
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