Excalibur Pathology, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

EXCALIBUR PATHOLOGY, INC.

Practice address

630 N Broadway St
Moore, OK 73160-4814

Phone

(405) 759-3953

Fax

(405) 759-7513

NPI assigned

Feb 21, 2007

Organization subpart

No

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

Authorized official

Name

Paula K Pierce

Title

President

Phone

(405) 759-3953

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851436232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 N BROADWAY ST",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731604814",
            "telephone_number": "405-759-3953",
            "fax_number": "405-759-7513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 N BROADWAY ST",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731604814",
            "telephone_number": "405-759-3953",
            "fax_number": "405-759-7513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCALIBUR PATHOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-759-3953"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Moore, OK
• Providers in Moore, 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 22, 2020; 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.