Provider Demographics
NPI:1932464369
Name:OKTX
Entity Type:Organization
Organization Name:OKTX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:REASTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-234-1014
Mailing Address - Street 1:7225 S 85TH EAST AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3157
Mailing Address - Country:US
Mailing Address - Phone:702-234-1014
Mailing Address - Fax:
Practice Address - Street 1:7225 S 85TH EAST AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3157
Practice Address - Country:US
Practice Address - Phone:702-234-1014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory