MEDICARE: PURMA BIOLOGICS, 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
2	261QG0250X	Genetics Clinic/Center

General Provider Information

NPI Number	:	1801534805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURMA BIOLOGICS, LLC

Provider Business Mailing Address
First Line	:	801 SW 89TH ST STE A2
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9355
Country	:	US
Telephone Number	:	405-822-2830
Fax Number	:	400-400-2024

Provider Business Practice Location Address
First Line	:	801 SW 89TH ST STE A2
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9355
Country	:	US
Telephone Number	:	405-900-5111
Fax Number	:	405-400-2024

Authorized Official
Title or Position	:	CEO
Name	:	DR. SEIFOLLAH AZADI
Credential	:	PHD
Telephone Number	:	405-822-2830

Provider Enumeration Date	:	05/20/2022
Last Update Date	:	02/08/2023

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