Provider Demographics
NPI:1982001137
Name:PBHC LABORATORIES
Entity Type:Organization
Organization Name:PBHC LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-699-8551
Mailing Address - Street 1:2305 SW H AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8103
Mailing Address - Country:US
Mailing Address - Phone:580-699-8551
Mailing Address - Fax:580-699-8553
Practice Address - Street 1:2305 SW H AVE STE 6
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8103
Practice Address - Country:US
Practice Address - Phone:580-699-8551
Practice Address - Fax:580-699-8553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory