Provider Demographics
NPI:1750600045
Name:QUEST MLSA
Entity type:Organization
Organization Name:QUEST MLSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSO
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-298-3001
Mailing Address - Street 1:903 W. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ANTLER
Mailing Address - State:OK
Mailing Address - Zip Code:74523-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:903 WEST MAIN
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2045
Practice Address - Country:US
Practice Address - Phone:580-298-3001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health