Provider Demographics
NPI:1700263605
Name:CHOICE CLINICAL LABORATORY, LLC
Entity Type:Organization
Organization Name:CHOICE CLINICAL LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:URALIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-805-4406
Mailing Address - Street 1:8210 NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-8518
Mailing Address - Country:US
Mailing Address - Phone:631-805-4406
Mailing Address - Fax:631-862-5080
Practice Address - Street 1:8210 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-8518
Practice Address - Country:US
Practice Address - Phone:631-805-4406
Practice Address - Fax:631-862-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory