NPIMap

Organization Active NPI

Diagnostic Laboratory of Oklahoma LLC

  • Clinical Medical Laboratory
  • Seminole, OK
National Provider Identifier
1114101730
Registry record updated Dec 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
DIAGNOSTIC LABORATORY OF OKLAHOMA LLC
Practice address
2401 W Wrangler Blvd
Seminole, OK 74868-1917
Phone
(405) 303-4000
NPI assigned
Dec 18, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
G Scott Cartier
Title
VP National Billing
Phone
(484) 676-7331

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D0944204SSM Health St Anthony Hospital-Shawnee, Seminole2401 Wrangler Blvd (Hospital), Seminole, OK 74868AccreditationMar 1, 2028
37D2175068SSM Health Medical Group2401 Wrangler Blvd (Mob), Seminole, OK 74868Certificate of waiverNov 13, 2027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040811000543 OK Part B Supplier - Independent Clinical Laboratory 9032181953 20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, OK; Yukon, OK; Tulsa, OK; Owasso, OK; Oklahoma City, OK; Grove, OK; Enid, OK; Edmond, OK

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X OK Primary

Addresses

NPPES NPI Registry

Primary practice location

2401 W Wrangler Blvd
Seminole, OK 74868-1917

Mailing address

2750 Monroe Blvd
Eagleville, PA 19403-2429
Phone (484) 676-7000

Other names 1

NPPES NPI Registry
  • Seminole Medical Center Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 18, 2007.

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1114101730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 MONROE BLVD",
            "city": "EAGLEVILLE",
            "state": "PA",
            "postal_code": "194032429",
            "telephone_number": "484-676-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W WRANGLER BLVD",
            "city": "SEMINOLE",
            "state": "OK",
            "postal_code": "748681917",
            "telephone_number": "405-303-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC LABORATORY OF OKLAHOMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "CARTIER",
        "authorized_official_first_name": "G",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "VP NATIONAL BILLING",
        "authorized_official_telephone_number": "484-676-7331"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seminole Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Seminole, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.