St. Mary's Laboratory, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

ST. MARY'S LABORATORY, LLC

Practice address

3517 W Owen K Garriott Rd
Suite 5
Enid, OK 73703-4952

Phone

(580) 234-6800

Fax

(580) 237-1828

NPI assigned

Jul 10, 2013

Last updated

Aug 28, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Johannessen

Title

Vice President

Phone

(903) 416-1726

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1373414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409184000000",
    "number": "1508207242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844737",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844737",
            "telephone_number": "903-416-1726",
            "fax_number": "903-416-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3517 W OWEN K GARRIOTT RD",
            "address_2": "SUITE 5",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737034952",
            "telephone_number": "580-234-6800",
            "fax_number": "580-237-1828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-10",
        "last_updated": "2014-08-28",
        "status": "A",
        "authorized_official_last_name": "JOHANNESSEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "903-416-1726"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200505130A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clint McKinley Sproul, O.D.
• Amanda Dawn Spurlock
• Jennifer Michelle Squires, M.A.
• SSM Health Care of Oklahoma, Inc (St Anthony Hematology/Oncology Enid)
• St Marys Anesthesia Group
• St. Mary's Physician Associates, LLC
• St. Mary's Physician Associates, LLC
• St. Mary's Physician Associates, LLC
• St. Mary's Regional Medical Center
• St. Mary's Regional Medical Center

• Clinical Medical Laboratory in Enid, OK
• Providers in Enid, 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 Aug 28, 2014; 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.