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Organization

FAMILY MEDICAL LAB, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. STAN LOUCKS MT(ASCP),MA (OWNER)
(580) 233-2909
Entity
Organization

Contact information

Practice address
915 E OWEN K GARRIOTT RD, SUITE E, ENID, OK 73701-6156
(580) 233-2909
(580) 233-2937
Mailing address
915 E OWEN K GARRIOTT RD, SUITE E, ENID, OK 73701-6156
(580) 233-2909
(580) 233-2937

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
37D0472553
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100758450A
OK
01
690120393
PALMETO GBA RR MEDICARE
OK
Enumeration date
09/29/2006
Last updated
02/02/2011
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