# OXYGEN MEDICAL DIAGNOSTIC LAB

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

## Provider details

- **NPI number:** 1104763895
- **Authorized official:** REGINA M ETIM HEALTHCARE SPECIALIS (CEO)
- **Authorized official phone:** (219) 306-0674

## Contact information

- **Practice address:** 8300 BROADWAY STE D2, MERRILLVILLE, IN 46410-8603
- **Practice address phone:** (219) 306-0674
- **Mailing address:** 8300 BROADWAY STE D2, MERRILLVILLE, IN 46410-8603
- **Mailing address phone:** (219) 306-0674

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 247ZC0005X | Clinical Laboratory Director (Non-physician) | — | NULL | Yes |
| 247ZC0005X | Clinical Laboratory Director (Non-physician) | — | — | Yes |

## Other

- **Enumeration date:** 04/30/2026
- **Last updated:** 04/30/2026