Provider Demographics
NPI:1043963630
Name:SOUTHERN PLAINS LABORATORIES LLC
Entity Type:Organization
Organization Name:SOUTHERN PLAINS LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SWAPNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RADADIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-660-6155
Mailing Address - Street 1:2222 W IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2738
Mailing Address - Country:US
Mailing Address - Phone:800-889-3000
Mailing Address - Fax:405-561-1008
Practice Address - Street 1:2222 W IOWA AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2738
Practice Address - Country:US
Practice Address - Phone:800-889-3000
Practice Address - Fax:405-561-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory