Provider Demographics
NPI:1790206043
Name:DAX LABORATORIES, LLC
Entity Type:Organization
Organization Name:DAX LABORATORIES, LLC
Other - Org Name:DAX LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-657-1156
Mailing Address - Street 1:PO BOX 18509
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73154-0509
Mailing Address - Country:US
Mailing Address - Phone:405-474-1162
Mailing Address - Fax:
Practice Address - Street 1:2821 NW 50TH ST STE 150
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8013
Practice Address - Country:US
Practice Address - Phone:405-657-1156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37D2128149291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory