MEDICARE: PRECISION HISTOLOGY LAB, INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700869559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION HISTOLOGY LAB, INC.

Provider Business Mailing Address
First Line	:	PO BOX 74940
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73147-0940
Country	:	US
Telephone Number	:	405-946-0118
Fax Number	:	405-946-5652

Provider Business Practice Location Address
First Line	:	3629 NW 19TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2815
Country	:	US
Telephone Number	:	405-946-0118
Fax Number	:	405-946-5652

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JANET C. LUNDY
Credential	:	HT(ASCP), HTL
Telephone Number	:	405-946-0118

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	12/14/2009

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