Provider Demographics
NPI:1679931802
Name:OKLAHOMA DRUG TESTING LLC
Entity type:Organization
Organization Name:OKLAHOMA DRUG TESTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HALSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-728-8020
Mailing Address - Street 1:9308 S TOLEDO AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2739
Mailing Address - Country:US
Mailing Address - Phone:918-728-8020
Mailing Address - Fax:918-728-8019
Practice Address - Street 1:9308 S TOLEDO AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2739
Practice Address - Country:US
Practice Address - Phone:918-728-8020
Practice Address - Fax:918-728-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3729208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty