Provider Demographics
NPI:1700869559
Name:PRECISION HISTOLOGY LAB, INC.
Entity Type:Organization
Organization Name:PRECISION HISTOLOGY LAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:HT(ASCP), HTL
Authorized Official - Phone:405-946-0118
Mailing Address - Street 1:PO BOX 74940
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73147-0940
Mailing Address - Country:US
Mailing Address - Phone:405-946-0118
Mailing Address - Fax:405-946-5652
Practice Address - Street 1:3629 NW 19TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2815
Practice Address - Country:US
Practice Address - Phone:405-946-0118
Practice Address - Fax:405-946-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200038780AMedicaid
OKOKB5785Medicare PIN