=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801836697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOY SNELL, MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2006
-----------------------------------------------------
Last Update Date | 01/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5404 SW DAUN
-----------------------------------------------------
City | LAWTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73505-6025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-536-7400
-----------------------------------------------------
Fax | 580-536-7402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5405 DAUN
-----------------------------------------------------
City | LAWTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73505-8508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-536-7400
-----------------------------------------------------
Fax | 580-536-7402
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INSURANCE
-----------------------------------------------------
Name | THERESE A SIMON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 580-531-5188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0101X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------