NPIMap

Organization Active NPI

Diagnostic Laboratory of Oklahoma LLC

  • Clinical Medical Laboratory
  • Oklahoma City, OK
National Provider Identifier
1346428893
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
37D0470622 Issued in OK
Legal business name
DIAGNOSTIC LABORATORY OF OKLAHOMA LLC
Practice address
4401 S Western Ave
Oklahoma City, OK 73109-3413
Phone
(405) 636-7041
NPI assigned
Feb 7, 2008
Organization subpart
Yes
Parent organization
DIAGNOSTIC LABORATORY OF OKLAHOMA LLCAs 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 37D0470622 OK Primary

Addresses

Primary practice location

4401 S Western Ave
Oklahoma City, OK 73109-3413

Mailing address

14275 Midway Rd Ste 400
Addison, TX 75001-3661

Other identifiers 1

IdentifierTypeStateIssuer
100758750JMedicaidOK

Other names 1

  • Integris Southwest Medical Center 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

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
37D0470622Integris Southwest Medical Center4401 South Western, Oklahoma City, OK 73109AccreditationJun 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Diagnostic Laboratory O14 organizations share this tax ID, including this one
Part of
Diagnostic Laboratory O

Other organizations with this tax ID 13

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

View all 13

Locations

4401 S Western Ave
Ste 2ND
Oklahoma City, OK 73109

NPI Registry JSON

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759276800000",
    "number": "1346428893",
    "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": "4401 S WESTERN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093413",
            "telephone_number": "405-636-7041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC LABORATORY OF OKLAHOMA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIAGNOSTIC LABORATORY OF OKLAHOMA LLC",
        "enumeration_date": "2008-02-07",
        "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": "37D0470622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100758750J",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integris Southwest Medical Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Integris Southwest Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Oklahoma City, 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.
  • 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.