Xyz Medical LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

XYZ MEDICAL LLC

Practice address

104 W Ohio Ave Ste 200
Coalgate, OK 74538-2827

Phone

(918) 423-7191

NPI assigned

Jul 23, 2014

Organization subpart

No

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

Authorized official

Name

Wendy Jimenez

Title

Authorized Official

Phone

(929) 368-9569

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1406073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784937600000",
    "number": "1457769473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 W OHIO AVE STE 200",
            "city": "COALGATE",
            "state": "OK",
            "postal_code": "745382827",
            "telephone_number": "929-368-9569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W OHIO AVE STE 200",
            "city": "COALGATE",
            "state": "OK",
            "postal_code": "745382827",
            "telephone_number": "918-423-7191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "XYZ MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-23",
        "last_updated": "2026-07-25",
        "certification_date": "2026-07-25",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "929-368-9569"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Niccole Smith
• Alyssia Leann Tomlinson, BS
• Jayson Alan Williams, MS
• Billy Ray Wilson Sr.
• Samantha Nicole Wood
• Kayley Ybarra, BHCM II
• Carol Yeager Hargis

• Clinical Medical Laboratory in Coalgate, OK
• Providers in Coalgate, OK by specialty
• Clinical Medical Laboratory in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2026; 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.