Organization
BLUE RIBBON 02 TESTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLADYS MCCLANAHAN (PRESIDENT)
(855) 270-2878
Entity
Organization
Contact information
Practice address
708 HODGE ST, SULPHUR SPRINGS, TX 75482-4230
(855) 270-2878
(855) 258-7422
Mailing address
708 HODGE ST, SULPHUR SPRINGS, TX 75482-4230
(855) 270-2878
(855) 258-7422
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OKB6030
MEDICARE PTAN
OK
Enumeration date
11/01/2010
Last updated
08/03/2011
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