Provider Demographics
NPI:1790234227
Name:BLACK SABLE LABORATORIES, LLC
Entity Type:Organization
Organization Name:BLACK SABLE LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-263-2690
Mailing Address - Street 1:PO BOX 330131
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-0131
Mailing Address - Country:US
Mailing Address - Phone:918-771-0437
Mailing Address - Fax:
Practice Address - Street 1:7580 E 151ST ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-4172
Practice Address - Country:US
Practice Address - Phone:918-771-0437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory