Provider Demographics
NPI:1134307044
Name:DIAGNOSTIC LABORATORY OF OKLAHOMA LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC LABORATORY OF OKLAHOMA LLC
Other - Org Name:MAYES COUNTY 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:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 N BAILEY ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4201
Practice Address - Country:US
Practice Address - Phone:918-825-6460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAGNOSTIC LABORATORY OF OKLAHOMA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory