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General NPI Number Information
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NPI Number | 1841657681
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Entity Type | Organization
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Legal Business Name | PHYSICIAN'S LABORATORY OF MIDWEST CITY, LLC
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 9230 E RENO AVE SUITE B
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City | MIDWEST CITY
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State | OK
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Zip | 73130-3337
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Country | US
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Telephone | 405-737-4900
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Fax | 405-737-3606
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Provider Business Mailing Address
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Address Line | 9230 E. RENO AVE. SUITE B
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City | MIDWEST CITY
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State | OK
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Zip | 73130
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Country | US
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Telephone | 405-737-4900
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Fax | 405-737-3606
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | MR. CARLO LEDESMA
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Credential | MT,ASAP,MS
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Telephone | 405-737-4900
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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 | OK
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