Provider Demographics
NPI:1184703944
Name:OKLAHOMA ALLERGY & ASTHMA CLINIC LAB
Entity type:Organization
Organization Name:OKLAHOMA ALLERGY & ASTHMA CLINIC LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-235-0040
Mailing Address - Street 1:PO BOX 26827
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0827
Mailing Address - Country:US
Mailing Address - Phone:405-235-0040
Mailing Address - Fax:405-235-4495
Practice Address - Street 1:750 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5051
Practice Address - Country:US
Practice Address - Phone:405-235-0040
Practice Address - Fax:405-235-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty