Organization
ST. MARY'S LABORATORY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN JOHANNESSEN (VICE PRESIDENT)
(903) 416-1726
Entity
Organization
Contact information
Practice address
3517 W OWEN K GARRIOTT RD, SUITE 5, ENID, OK 73703-4952
(580) 234-6800
(580) 237-1828
Mailing address
PO BOX 844737, DALLAS, TX 75284-4737
(903) 416-1726
(903) 416-1701
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200505130A
—
OK
Enumeration date
07/10/2013
Last updated
08/28/2014
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