| Pathology Lab | |
|
940 Stanton L Young Blvd Room 415 Oklahoma City OK 73104-5020 | |
| (405) 271-2422 | |
| Not Available |
| Full Name | Pathology Lab |
|---|---|
| Speciality | Clinic/Center |
| Location | 940 Stanton L Young Blvd, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | John P Zubialde (EXECUTIVE DEAN) |
| Authorized Official Contact | 4052711515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pathology Lab Po Box 269025 Oklahoma City OK 73126-9025 Ph: (405) 271-1500 | Pathology Lab 940 Stanton L Young Blvd Room 415 Oklahoma City OK 73104-5020 Ph: (405) 271-2422 |
| NPI Number | 1609052927 |
|---|---|
| Provider Enumeration Date | 01/16/2008 |
| Last Update Date | 01/06/2020 |
| Medicare PECOS PAC ID | 2860304334 |
|---|---|
| Medicare Enrollment ID | O20050906000857 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609052927 | NPI | - | NPPES |
| 100758710A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Michael Sughrue |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1497977359 PECOS PAC ID: 6709044142 Enrollment ID: I20120215000125 |
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