NPIMap

Organization Active NPI

Digestive Disease Pathology LLC

  • Clinical Medical Laboratory
  • Oklahoma City, OK
National Provider Identifier
1487807343
Registry record updated Oct 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
DIGESTIVE DISEASE PATHOLOGY LLC
Practice address
3366 NW Expressway
Suite 350
Oklahoma City, OK 73112-4462
Phone
(405) 767-6630
Fax
(405) 767-1176
NPI assigned
Oct 23, 2008
Last updated
Oct 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2008

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

Authorized official

Name
Bill R Davis
Title
Administrator
Phone
(405) 767-6630

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

3366 NW Expressway
Suite 350
Oklahoma City, OK 73112-4462

Mailing address

5015 N Penn Ave
Suite 303
Oklahoma City, OK 73112-8891
Phone (405) 767-6630

Other identifiers 1

IdentifierTypeStateIssuer
37D1088518OtherOKCLIA NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090601000073 OK Part B Supplier - Independent Clinical Laboratory 3375692999 Practice locations: Oklahoma City, OK

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3366 NW Expressway
Ste 350
Oklahoma City, OK 73112
Phone (405) 767-6630

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1224720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224720000000",
    "number": "1487807343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5015 N PENN AVE",
            "address_2": "SUITE 303",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731128891",
            "telephone_number": "405-767-6630",
            "fax_number": "405-767-1176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3366 NW EXPRESSWAY",
            "address_2": "SUITE 350",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731124462",
            "telephone_number": "405-767-6630",
            "fax_number": "405-767-1176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGESTIVE DISEASE PATHOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-23",
        "last_updated": "2008-10-23",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "BILL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "405-767-6630"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "37D1088518",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 23, 2008; 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.