Provider Demographics
NPI:1003089574
Name:NW OKLAHOMA PATHOLOGISTS-CLINIC
Entity Type:Organization
Organization Name:NW OKLAHOMA PATHOLOGISTS-CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-233-2611
Mailing Address - Street 1:PO BOX 3008
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-3008
Mailing Address - Country:US
Mailing Address - Phone:580-233-2611
Mailing Address - Fax:580-233-1648
Practice Address - Street 1:330 S 5TH ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5825
Practice Address - Country:US
Practice Address - Phone:580-233-2611
Practice Address - Fax:580-233-2611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NW OKLAHOMA PATHOLOGISTS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34929Medicare UPIN