MEDICARE: MMS LAB SERVICES 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	37D2091127	OK

General Provider Information

NPI Number	:	1316302086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MMS LAB SERVICES LLC

Provider Business Mailing Address
First Line	:	1415 NW 43RD ST
Second Line	:	SUITE C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-5021
Country	:	US
Telephone Number	:	806-239-6862
Fax Number	:	806-209-0000

Provider Business Practice Location Address
First Line	:	1415 NW 43RD ST
Second Line	:	SUITE C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-5021
Country	:	US
Telephone Number	:	806-239-6862
Fax Number	:	806-209-0000

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. JOHN MURGAI
Credential	:
Telephone Number	:	806-239-6862

Provider Enumeration Date	:	12/23/2015
Last Update Date	:	12/23/2015

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