Provider Demographics
NPI:1497773337
Name:REGIONAL MEDICAL LABORATORY, INC
Entity Type:Organization
Organization Name:REGIONAL MEDICAL LABORATORY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:TERRENCE
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-744-2553
Mailing Address - Street 1:4142 S MINGO RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3632
Mailing Address - Country:US
Mailing Address - Phone:918-744-2553
Mailing Address - Fax:918-744-3482
Practice Address - Street 1:4142 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3632
Practice Address - Country:US
Practice Address - Phone:918-744-2553
Practice Address - Fax:918-744-3482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37D0656684291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100757670BMedicaid
OK=========008OtherBLUE CROSS OTHER
OK=========001OtherBLUE CROSS SJMC
OK=========CMedicare PIN