Organization
GRADY MEMORIAL HOSPITAL
Active
Other names
FOMG Clinical Medical Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE PAUTLER (CEO)
(405) 779-2150
Entity
Organization
Contact information
Practice address
2100 W IOWA AVE, CHICKASHA, OK 73018-2736
(405) 224-2100
(405) 779-2346
Mailing address
2100 W IOWA AVE, CHICKASHA, OK 73018-2736
(405) 224-2100
(405) 779-2346
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100700820H
—
OK
Enumeration date
10/31/2006
Last updated
01/06/2026
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