Organization
PHYSICIAN'S LABORATORY OF MIDWEST CITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLO LEDESMA MT,ASAP,MS (LABORATORY DIRECTOR)
(405) 737-4900
Entity
Organization
Contact information
Practice address
9230 E RENO AVE, SUITE B, MIDWEST CITY, OK 73130-3337
(405) 737-4900
(405) 737-3606
Mailing address
9230 E. RENO AVE., SUITE B, MIDWEST CITY, OK 73130
(405) 737-4900
(405) 737-3606
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37D2100658
CLIA
OK
Enumeration date
01/25/2016
Last updated
02/16/2016
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