NPIMap

Organization Active NPI

State of Oklahoma

  • Clinical Medical Laboratory
  • Tulsa, OK
National Provider Identifier
1447662010
Registry record updated Aug 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
37D2076904 Issued in OK
Legal business name
STATE OF OKLAHOMA
Practice address
1111 W 17TH St
Tulsa, OK 74107-1886
Phone
(918) 561-1421
NPI assigned
May 29, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2017

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

Authorized official

Name
Dr. Jarrad R Wagner, PHD
Title
Associate Professor & Director
Phone
(918) 561-8247

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 37D2076904 OK Primary

Addresses

Primary practice location

1111 W 17TH St
Tulsa, OK 74107-1886

Mailing address

1111 W 17TH St
Tulsa, OK 74107-1886
Phone (918) 561-1421

Other identifiers 1

IdentifierTypeStateIssuer
200217940KMedicaidOK

Other names 1

  • OSU Clinical Lab Services Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504137600000",
    "number": "1447662010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W 17TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741071886",
            "telephone_number": "918-561-1421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W 17TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741071886",
            "telephone_number": "918-561-1421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF OKLAHOMA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-29",
        "last_updated": "2017-08-31",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "JARRAD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ASSOCIATE PROFESSOR & DIRECTOR",
        "authorized_official_telephone_number": "918-561-8247",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OK",
            "license": "37D2076904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200217940K",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSU Clinical Lab Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.