Provider Demographics
NPI:1801836697
Name:JOY SNELL, MD INC
Entity Type:Organization
Organization Name:JOY SNELL, MD INC
Other - Org Name:ADVANCED PATHOLOGY, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-531-5188
Mailing Address - Street 1:5405 DAUN
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8508
Mailing Address - Country:US
Mailing Address - Phone:580-536-7400
Mailing Address - Fax:580-536-7402
Practice Address - Street 1:5404 SW DAUN
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6025
Practice Address - Country:US
Practice Address - Phone:580-536-7400
Practice Address - Fax:580-536-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200109400AMedicaid
OK=========0001OtherBCBS
OK900522069Medicare PIN
P00218759Medicare PIN
DD2814Medicare PIN