MEDICARE: LIFE CHECK LAB, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1053350991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CHECK LAB, LLC

Provider Business Mailing Address
First Line	:	3000 UNITED FOUNDERS BLVD
Second Line	:	SUITE 137
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3958
Country	:	US
Telephone Number	:	405-917-1896
Fax Number	:	405-917-7768

Provider Business Practice Location Address
First Line	:	3000 UNITED FOUNDERS BLVD
Second Line	:	SUITE 137
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3958
Country	:	US
Telephone Number	:	405-917-1896
Fax Number	:	405-917-7768

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MS. CYNTHIA L. PICKENS
Credential	:
Telephone Number	:	405-917-1896

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	04/05/2010

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