# TULSA MEDICAL LABORATORY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063743052
- **Authorized official:** RICK D GILLIS (BUSINESS MANAGER)
- **Authorized official phone:** (918) 712-5571

## Contact information

- **Practice address:** 6565 S YALE AVE, SUITE 410, TULSA, OK 74136-8327
- **Practice address phone:** (918) 481-7859
- **Practice address fax:** (918) 747-7831
- **Mailing address:** 2738 E 51ST ST, SUITE 290, TULSA, OK 74105-6231
- **Mailing address phone:** (918) 712-5571
- **Mailing address fax:** (918) 747-7831

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/15/2010
- **Last updated:** 01/28/2010