STATE OF OKLAHOMA (NPI# 1447662010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447662010 |
| Entity Type | Organization |
| Organization Name | STATE OF OKLAHOMA |
| Other Organization Name | OSU CLINICAL LAB SERVICES |
| Practice Address |
1111 W 17th St Tulsa OK 74107-1886 |
| Practice Telephone | 9185611421 |
| Mailing Telephone | 9185611421 |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2017-08-31 |
| Authorized Official Name | DR. JARRAD R WAGNER (ASSOCIATE PROFESSOR & DIRECTOR) |
| Authorized Official Telephone | 9185618247 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | 37D2076904 | OK | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200217940K | 05 |
| Other Name | Type Code |
|---|---|
| OSU Clinical Lab Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225352057 | State of Oklahoma | Community/Behavioral Health | 400 North Oak, Taft, OK 74463 | 2010-03-23 |
| 1790922185 | State of Oklahoma | Community Based Residential Treatment Facility, Mental Illness | 2323 South Harvard, Tulsa, OK 74114 | 2009-01-07 |
| 1124286059 | State of Oklahoma | Pharmacy | 304 Fairlane Ave, Sulphur, OK 73086-6861 | 2008-05-28 |
| 1154589430 | State of Oklahoma | Skilled Nursing Facility | 10014 Se 1138th Street, Talihina, OK 74571-6028 | 2008-05-23 |
| 1225295710 | State of Oklahoma | Skilled Nursing Facility | 1701 South 4th, Clinton, OK 73601-1209 | 2008-05-21 |
| 1881872182 | State of Oklahoma | Skilled Nursing Facility | 900 E. Airport Rd., Okmulgee, OK 74447 | 2008-02-08 |
| 1720152788 | State of Oklahoma | Community/Behavioral Health | 702 N. Grand, Northwest Center for Behavioral Health, Enid, OK 73701 | 2006-11-20 |
| 1750456588 | State of Oklahoma | Community/Behavioral Health | 1222 10th Street, Suite 211, Northwest Center for Behavioral Health, Woodward, OK 73801-3156 | 2006-11-20 |
| 1700950201 | State of Oklahoma | Substance Abuse Rehabilitation Facility | 5050 Williams Avenue, Northwest Center for Behavioral Health, Woodward, OK 73801 | 2006-11-17 |
| 1922171701 | State of Oklahoma | Psychiatric Hospital | 1 Mile East U.S. Highway 270, Fort Supply, OK 73841-0001 | 2006-11-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | STATE OF OKLAHOMA EAST CENTRAL UNIVERSITY | 1100 E 14th St, Ada, OK 74820-6999 |
| Street Address |
1111 W 17TH ST |
| City | TULSA |
| State | OK |
| Zip Code | 74107-1886 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205162393 | Bruce Allen Benjamin | Specialist | 1111 W 17th St, Tulsa, OK 74107-1800 | 2009-10-23 |
| 1902423296 | Emily Madrak | Specialist/Technologist | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-07-02 |
| 1043839012 | Travis John Brachtenbach | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-04-10 |
| 1316575913 | Hallie Frederick | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-30 |
| 1285262899 | Jonathon Gurule | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-30 |
| 1194353086 | Dipa Puwar | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-28 |
| 1215564372 | Fernando Magana Herrera | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-26 |
| 1427685536 | Desiree C Lyon | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-26 |
| 1568099794 | Jennifer Cox | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-26 |
| 1487281705 | Mohammed Shaban | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508493784 | Squareone Compassion Inc | Clinic/Center | 5323 South 65th West Avenue, Tulsa, OK 74107 | 2020-03-26 |
| 1649772476 | Lauren Michele Rogers | Student in an Organized Health Care Education/Training Program | 1111 W. 17th St., Barson 241, Tulsa, OK 74107 | 2018-03-07 |
| 1336641828 | Frank Patrick Goodman | Student in an Organized Health Care Education/Training Program | 2345 Sw Blvd, Tulsa, OK 74107 | 2018-03-01 |
| 1659827269 | Careatc - America Waste | Clinic/Center | 23322 Southwest Blvd, Tulsa, OK 74107 | 2016-09-01 |
| 1538530886 | Jeremy Michael Bowles | Pharmacist | 4227 Southwest Boulevard, Tulsa, OK 74107 | 2015-10-13 |
| 1760725865 | Nicholas Alexander | Student in an Organized Health Care Education/Training Program | 2345 Southwest Blvd., Osu Health Care Center, Tulsa, OK 74107 | 2013-03-27 |
| 1295095321 | Robert Steven Wedding | Counselor | 6033 S. 31 St. West Ave., Tulsa, OK 74107 | 2012-05-23 |
| 1295911451 | American Current Care P.a. | Clinic/Center | 5682 W Skelly Drive, Tulsa, OK 74107 | 2008-01-17 |
| 1821200072 | Leeca Jenkins | Counselor | 2007 W. 57th St, Tulsa, OK 74107 | 2007-05-03 |
| 1477670552 | Occupational Health Centers of The Southwest, P.a. | Clinic/Center | 5682 W. Skelly Drive, Tulsa, OK 74107 | 2007-03-23 |
| Find all providers in zip 74107 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 1891280541 | Wellness Federal Labs, LLC | Clinical Medical Laboratory | 5272 S Lewis Ave Ste 121, Tulsa, OK 74105-6563 | 2018-06-26 |
| 1225579915 | Cogent Medical Lab LLC | Clinical Medical Laboratory | 6914 S Yorktown Ave Ste 110, Tulsa, OK 74136-3933 | 2017-03-14 |
| 1982150231 | Taylum Medical LLC | Clinical Medical Laboratory | 3144 S Winston Ave, Tulsa, OK 74135-2012 | 2016-08-28 |
| 1326495433 | Oklahoma State University | Clinical Medical Laboratory | 1111 W 17th St # A-220, Tulsa, OK 74107-1886 | 2016-05-18 |
| 1336556745 | Certigen Laboratory, LLC | Clinical Medical Laboratory | 9309 S Toledo Ave, Suite A, Tulsa, OK 74137-2752 | 2014-07-17 |
| 1578978573 | Precision Analysis Laboratory, LLC | Clinical Medical Laboratory | 2811 E 15th St, Suite 102, Tulsa, OK 74104-5245 | 2014-06-27 |
| 1700213667 | Caldwell Toxicology Labs LLC | Clinical Medical Laboratory | 7133 Riverside Parkway, Suite A, Tulsa, OK 74136 | 2013-10-08 |
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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.