NPIMap

Organization Active NPI

Diagnostic Laboratory of Oklahoma LLC

  • Clinical Medical Laboratory
  • Grove, OK
National Provider Identifier
1396928461
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
37D0700830 Issued in OK
Legal business name
DIAGNOSTIC LABORATORY OF OKLAHOMA LLC
Practice address
1001 E 18TH St
Suite a
Grove, OK 74344-2907
Phone
(918) 786-2243
NPI assigned
Dec 12, 2007
Organization subpart
No

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 37D0700830 OK Primary

Addresses

Primary practice location

1001 E 18TH St
Suite a
Grove, OK 74344-2907

Mailing address

14275 Midway Rd Ste 400
Addison, TX 75001-3661

Other identifiers 1

IdentifierTypeStateIssuer
100758750GMedicaidOK

Other names 1

  • GROVE GENERAL HOSPTIAL 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
37D0700830Integris Grove Hospital1001 E 18TH Street, Suite a, Grove, OK 74344AccreditationJan 2, 2027

National Provider Directory

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

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": "1197417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759276800000",
    "number": "1396928461",
    "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": "1001 E 18TH ST",
            "address_2": "SUITE A",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743442907",
            "telephone_number": "918-786-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC LABORATORY OF OKLAHOMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-12",
        "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": "37D0700830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100758750G",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GROVE GENERAL HOSPTIAL",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "GROVE GENERAL HOSPTIAL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grove, 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.