Provider Demographics
NPI:1114798212
Name:HUNTERS GRAND CLINICAL ANALYTICS, LLC
Entity Type:Organization
Organization Name:HUNTERS GRAND CLINICAL ANALYTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-605-0720
Mailing Address - Street 1:10120 BROADWAY EXT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6300
Mailing Address - Country:US
Mailing Address - Phone:405-608-0720
Mailing Address - Fax:
Practice Address - Street 1:6111 E SKELLY DR STE 1200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6100
Practice Address - Country:US
Practice Address - Phone:405-608-0720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory