NPIMap

Organization Active NPI

Diagnostic Laboratory of Oklahoma LLC

  • Clinical Medical Laboratory
  • Owasso, OK
National Provider Identifier
1255517348
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
37D1059452 Issued in OK
Legal business name
DIAGNOSTIC LABORATORY OF OKLAHOMA LLC
Practice address
10502 N 110TH East Ave
Owasso, OK 74055-6655
Phone
(918) 376-8150
NPI assigned
Jan 18, 2008
Last updated
Oct 1, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
DIAGNOSTIC LABORATORY OF OKLAHOMAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
R'Nee Mullen
Title
Ceo
Phone
(405) 608-6290

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 37D1059452 OK Primary

Addresses

Primary practice location

10502 N 110TH East Ave
Owasso, OK 74055-6655

Mailing address

14275 Midway Rd Ste 400
Addison, TX 75001-3661

Other names 1

  • Owasso Oklahoma Other name

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

Other NPIs on the same Medicare enrollment 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Diagnostic Lab of Ok14 organizations share this tax ID, including this one
Part of
Diagnostic Lab of Ok

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759276800000",
    "number": "1255517348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14275 MIDWAY RD STE 400",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10502 N 110TH EAST AVE",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740556655",
            "telephone_number": "918-376-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC LABORATORY OF OKLAHOMA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIAGNOSTIC LABORATORY OF OKLAHOMA",
        "enumeration_date": "2008-01-18",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A",
        "authorized_official_last_name": "MULLEN",
        "authorized_official_first_name": "R'NEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-608-6290"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OK",
            "license": "37D1059452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Owasso Oklahoma",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Owasso Oklahoma",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Owasso, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.