Provider Demographics
NPI:1669021622
Name:NATIONAL LABORATORY CORPORATION
Entity Type:Organization
Organization Name:NATIONAL LABORATORY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-830-5601
Mailing Address - Street 1:4554 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2906
Mailing Address - Country:US
Mailing Address - Phone:918-830-5601
Mailing Address - Fax:541-488-7721
Practice Address - Street 1:5805 E 15TH ST STE 104
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-6401
Practice Address - Country:US
Practice Address - Phone:918-830-5601
Practice Address - Fax:541-488-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory