Physician's Laboratory of Midwest City, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PHYSICIAN'S LABORATORY OF MIDWEST CITY, LLC

Practice address

9230 E Reno Ave
Suite B
Midwest City, OK 73130-3337

Phone

(405) 737-4900

Fax

(405) 737-3606

NPI assigned

Jan 25, 2016

Last updated

Feb 16, 2016By 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

Mr. Carlo Ledesma, MT,ASAP,MS

Title

Laboratory Director

Phone

(405) 737-4900

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1841657681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9230 E. RENO AVE.",
            "address_2": "SUITE B",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "73130",
            "telephone_number": "405-737-4900",
            "fax_number": "405-737-3606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9230 E RENO AVE",
            "address_2": "SUITE B",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731303337",
            "telephone_number": "405-737-4900",
            "fax_number": "405-737-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN'S LABORATORY OF MIDWEST CITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-25",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "LEDESMA",
        "authorized_official_first_name": "CARLO",
        "authorized_official_title_or_position": "LABORATORY DIRECTOR",
        "authorized_official_telephone_number": "405-737-4900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MT,ASAP,MS"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "37D2100658",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mindy Dawn Pham, CCC-SLP
• Pharmerica Hospital Pharmacy Services, Inc. (Specialty Hospital of Midwest City)
• Nicole Pharris, RBT
• Natasha Louise Phillips
• Nicole L Phillips
• Darrell J Pickard, M.D.
• Lucille Ray Pierce
• Pinky Promise Keepers PLLC
• Walter Lee Pipkin, DDS
• Tiana Patrice Pitter

• Clinical Medical Laboratory in Midwest City, OK
• Providers in Midwest City, 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 Feb 16, 2016; 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.