Provider Demographics
NPI:1881178010
Name:PROGENTEC DIAGNOSTICS INC.
Entity type:Organization
Organization Name:PROGENTEC DIAGNOSTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PURUSHOTHAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-216-4818
Mailing Address - Street 1:755 RESEARCH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-3620
Mailing Address - Country:US
Mailing Address - Phone:405-216-4818
Mailing Address - Fax:833-335-3314
Practice Address - Street 1:655 RESEARCH PKWY STE 538
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-6276
Practice Address - Country:US
Practice Address - Phone:405-216-4818
Practice Address - Fax:833-335-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory