Provider Demographics
NPI: | 1679031256 |
---|---|
Name: | NEO SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | NEO SERVICES, LLC |
Other - Org Name: | NORTHEASTERN OKLAHOMA PHYSICIAN GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | COLLEEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PAYNE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 918-744-1001 |
Mailing Address - Street 1: | 7020 S UTICA AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | TULSA |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74136-3907 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 918-728-8904 |
Mailing Address - Fax: | 918-744-9729 |
Practice Address - Street 1: | 7020 S UTICA AVE |
Practice Address - Street 2: | |
Practice Address - City: | TULSA |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74136-3907 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-728-8904 |
Practice Address - Fax: | 918-744-9729 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-03-04 |
Last Update Date: | 2020-08-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OK | 200517820A | Medicaid |