Southern Oklahoma Pathology Assoc., Inc.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

8286 Issued in OK

Legal business name

SOUTHERN OKLAHOMA PATHOLOGY ASSOC., INC.

Practice address

421 N Monte Vista St
Ada, OK 74820-4609

Phone

(580) 332-9595

Fax

(580) 332-4921

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John Wesley Mooring, M. D.NPI 1174734495

Title

Owner

Phone

(800) 288-8325

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Wesley Mooring, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Ada, OK
  • NPI 1174734495
  Medicare reassignment Care Compare group NPD Authorized official
• Kevin W Maddox, DO

  • Anatomic Pathology & Clinical Pathology Physician
  • Ada, OK
  • NPI 1598082398
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1508978149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 N MONTE VISTA ST",
            "address_2": "PATHOLOGY DEPARTMENT",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204609",
            "telephone_number": "580-332-9595",
            "fax_number": "580-332-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 N MONTE VISTA ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204609",
            "telephone_number": "580-332-9595",
            "fax_number": "580-332-4921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OKLAHOMA PATHOLOGY ASSOC., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "MOORING",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WESLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "800-288-8325",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OK",
            "license": "8286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CO5064",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100758421B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeastern Oklahoma Neurosciences
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• Southern Oklahoma Internal Medicine P C
• Southern Oklahoma Lifeline LLC
• Southern Oklahoma Pediatrics Inc
• Southern Oklahoma Psychological Associates Inc.
• Southern Oklahoma Treatment Serices, Inc.
• Southern Oklahoma Urology, Inc
• Southwest Medical Specialist

• Anatomic Pathology & Clinical Pathology Physician in Ada, OK
• Providers in Ada, OK by specialty
• Anatomic Pathology & Clinical Pathology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.