Provider Demographics
NPI:1114101730
Name:DIAGNOSTIC LABORATORY OF OKLAHOMA LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC LABORATORY OF OKLAHOMA LLC
Other - Org Name:SEMINOLE MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VP NATIONAL BILLING
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CARTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-676-7331
Mailing Address - Street 1:2750 MONROE BLVD
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2429
Mailing Address - Country:US
Mailing Address - Phone:484-676-7000
Mailing Address - Fax:
Practice Address - Street 1:2401 W WRANGLER BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-1917
Practice Address - Country:US
Practice Address - Phone:405-303-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory