Provider Demographics
NPI:1316135023
Name:MIDLAND STATS
Entity type:Organization
Organization Name:MIDLAND STATS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-464-5918
Mailing Address - Street 1:3000 UNITED FOUNDERS BLVD
Mailing Address - Street 2:225H
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3958
Mailing Address - Country:US
Mailing Address - Phone:405-464-5918
Mailing Address - Fax:918-512-4441
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD
Practice Address - Street 2:225H
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73113-3958
Practice Address - Country:US
Practice Address - Phone:405-464-5918
Practice Address - Fax:918-512-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory