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?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200517820AMedicaid