Provider Demographics
NPI:1154783074
Name:ALPHA MEDICAL LABORATORY LLC
Entity type:Organization
Organization Name:ALPHA MEDICAL LABORATORY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-949-5544
Mailing Address - Street 1:2448 E 81ST ST STE 4000
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4300
Mailing Address - Country:US
Mailing Address - Phone:918-398-0944
Mailing Address - Fax:918-939-9098
Practice Address - Street 1:2448 E 81ST ST STE 4000
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4300
Practice Address - Country:US
Practice Address - Phone:918-983-0944
Practice Address - Fax:918-399-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral DisturbancesGroup - Multi-Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient