Organization
SOUTHWEST PATHOLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELVIN J VAN BOVEN DO (AUTHORIZED OFFICIAL)
(918) 582-0001
Entity
Organization
Contact information
Practice address
8803 S. 101ST E. AVE, SUITE 360, TULSA, OK 74133
(918) 582-0001
(918) 582-0003
Mailing address
PO BOX 26303, OKLAHOMA CITY, OK 73126-0303
(918) 582-0001
(918) 582-0003
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100245110A
—
KS
05
—
100739510A
—
OK
01
—
175079901
DEPT OF LABOR
—
01
—
4033986
BLUECROSS BLUESHIELD
TN
05
—
703687004
—
MO
Enumeration date
09/12/2006
Last updated
08/11/2021
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