NPIMap

Organization Active NPI

Diagnostic Laboratory of Oklahoma, LLC

  • Clinical Medical Laboratory
  • Oklahoma City, OK
National Provider Identifier
1972885044
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
DIAGNOSTIC LABORATORY OF OKLAHOMA, LLC
Practice address
11200 N Portland Ave
Oklahoma City, OK 73120-5045
Phone
(405) 936-1566
NPI assigned
Sep 15, 2011
Organization subpart
Yes
Parent organization
DIAGNOSTIC LABORATORY OF OKLAHOMAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

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

Authorized official

Name
R'Nee Mullen
Title
Ceo
Phone
(405) 608-6290

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

11200 N Portland Ave
Oklahoma City, OK 73120-5045

Mailing address

14275 Midway Rd Ste 400
Addison, TX 75001-3661

Other identifiers 1

IdentifierTypeStateIssuer
100758750MedicaidOK

Other names 1

  • Lakeside Women's Hospital Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040811000543 OK Part B Supplier - Independent Clinical Laboratory 9032181953 20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, OK; Yukon, OK; Tulsa, OK; Owasso, OK; Oklahoma City, OK; Grove, OK; Enid, OK; Edmond, OK

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D0470865Oklahoma City GYN & OB LLC11200 N Portland Avenue, Oklahoma City, OK 73120Provider-performed microscopyAug 31, 2026
37D2028222Lakeside Women'S Hospital11200 North Portland Avenue, Oklahoma City, OK 73120AccreditationDec 25, 2026

National Provider Directory

National Provider Directory
Tax ID family
Diagnostic Laboratory O14 organizations share this tax ID, including this one
Part of
Diagnostic Laboratory O

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759276800000",
    "number": "1972885044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14275 MIDWAY RD STE 400",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 N PORTLAND AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731205045",
            "telephone_number": "405-936-1566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC LABORATORY OF OKLAHOMA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIAGNOSTIC LABORATORY OF OKLAHOMA",
        "enumeration_date": "2011-09-15",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A",
        "authorized_official_last_name": "MULLEN",
        "authorized_official_first_name": "R'NEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-608-6290"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100758750",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Women's Hospital",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Lakeside Women's Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.