STATELINE MEDICAL LLC (NPI# 1114421260) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114421260 |
| Entity Type | Organization |
| Organization Name | STATELINE MEDICAL LLC |
| Practice Address |
105 N Pocola Blvd Suite 2 Pocola OK 74902-3101 |
| Practice Telephone | 4795612448 |
| Mailing Telephone | 4795612448 |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2018-03-22 |
| Authorized Official Name | SHANE WALKER (OWNER) |
| Authorized Official Telephone | 4795612448 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | OK | Laboratories |
| Street Address |
105 N POCOLA BLVD SUITE 2 |
| City | POCOLA |
| State | OK |
| Zip Code | 74902-3101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477009611 | Ashlyn Beasley | Case Manager/Care Coordinator | 504 Morris St, Pocola, OK 74902 | 2016-08-28 |
| 1881721637 | Pocola Nursing Center LLC | Skilled Nursing Facility | 200 Home Street, Pocola, OK 74902 | 2007-02-28 |
| 1780776237 | Pocola Public Schools | Public Health or Welfare | 603 E Pryor Ave, Pocola, OK 74902-1901 | 2006-09-29 |
| 1467094524 | Tahlina Weir | Counselor | 205 Cottonwood, Pocola, OK 74902-2340 | 2019-10-10 |
| 1053787283 | Amanda Combs | Nurse Practitioner | 202 Beam Ln, Pocola, OK 74902-2463 | 2015-08-11 |
| 1841458262 | John Thomas Coulbourn | Counselor | 1405 Blair St, Pocola, OK 74902-2860 | 2008-06-02 |
| 1487275699 | Stateline Medical Lab LLC | Clinical Medical Laboratory | 105 N Pocola Blvd Ste 2, Pocola, OK 74902-3101 | 2020-04-28 |
| 1023362779 | Kal Home Health Inc | Home Health | 302 N Pocola Blvd, Pocola, OK 74902-3102 | 2012-11-02 |
| 1174785091 | Shane Thomas Walker | Chiropractor | 1406 N Pocola Blvd, Pocola, OK 74902-3139 | 2008-07-01 |
| 1225238447 | Haisten Enterprises PC | Pharmacy | 102 E Folsom Blvd, Pocola, OK 74902-3150 | 2007-07-25 |
| Find all providers in zip 74902 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487275699 | Stateline Medical Lab LLC | Clinical Medical Laboratory | 105 N Pocola Blvd Ste 2, Pocola, OK 74902-3101 | 2020-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427657360 | Chrom Medical Labs | Clinical Medical Laboratory | 12816 S Memorial Dr Unit 121, Bixby, OK 74008-2593 | 2020-10-21 |
| 1043835143 | Qitek Labs of Oklahoma, LLC | Clinical Medical Laboratory | 3636 Nw 63rd St Ste C, Oklahoma City, OK 73116-2011 | 2020-06-15 |
| 1790307395 | Arc Diagnostics, LLC | Clinical Medical Laboratory | 8551 N 125th East Ave Ste 150, Owasso, OK 74055-2110 | 2020-05-18 |
| 1417583162 | Imaginus Diagnostic Laboratory LLC | Clinical Medical Laboratory | 17673 Us Highway 271, Spiro, OK 74959-5300 | 2020-03-13 |
| 1366089633 | Wellness Labs, LLC | Clinical Medical Laboratory | 5272 S Lewis Ave Ste 120, Tulsa, OK 74105-6563 | 2019-12-05 |
| 1669021622 | National Laboratory Corporation | Clinical Medical Laboratory | 5805 E 15th St Ste 104, Tulsa, OK 74112-6401 | 2019-09-11 |
| 1720636806 | Axiom Biogenomics, LLC | Clinical Medical Laboratory | 7335 S Lewis Ave Ste 120, Tulsa, OK 74136-6830 | 2019-08-31 |
| 1881178010 | Progentec Diagnostics Inc. | Clinical Medical Laboratory | 825 Ne 13th St Ste Mc302.4, Oklahoma City, OK 73104-5005 | 2018-09-24 |
| 1891280541 | Wellness Federal Labs, LLC | Clinical Medical Laboratory | 5272 S Lewis Ave Ste 121, Tulsa, OK 74105-6563 | 2018-06-26 |
| 1598284358 | Stephanie Sue Mcquarters | Clinical Medical Laboratory | 1840 South Lion Avenue, Broken Arrow, OK 74012 | 2017-09-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.