Provider Demographics
NPI:1316388804
Name:DELTA LABORATORY, LLC
Entity Type:Organization
Organization Name:DELTA LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOHLGEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-608-4107
Mailing Address - Street 1:5909 NW EXPRESSWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 N MERIDIAN AVE STE 100-S
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6560
Practice Address - Country:US
Practice Address - Phone:405-608-4107
Practice Address - Fax:405-217-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory