Basic Information
| Provider Information | |||||||||
| NPI: | 1114101730 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIAGNOSTIC LABORATORY OF OKLAHOMA LLC | ||||||||
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| OtherOrganizationName: | SEMINOLE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 MONROE BLVD | ||||||||
| Address2: | |||||||||
| City: | EAGLEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194032429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846767000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2401 W WRANGLER BLVD | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748681917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053034000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2007 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | CARTIER | ||||||||
| AuthorizedOfficialFirstName: | G | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | VP NATIONAL BILLING | ||||||||
| AuthorizedOfficialTelephone: | 4846767331 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | OK | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.