Provider Demographics
NPI:1033866132
Name:GREAT PLAINS MICROBIOLOGY LLC
Entity Type:Organization
Organization Name:GREAT PLAINS MICROBIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-820-2825
Mailing Address - Street 1:755 RESEARCH PKWY STE 459
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-3629
Mailing Address - Country:US
Mailing Address - Phone:405-406-4777
Mailing Address - Fax:
Practice Address - Street 1:755 RESEARCH PKWY STE 459
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3629
Practice Address - Country:US
Practice Address - Phone:405-406-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory