Provider Demographics
NPI:1720085822
Name:INOVEON CORPORATION
Entity type:Organization
Organization Name:INOVEON CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:G. CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:405-271-9025
Mailing Address - Street 1:800 RESEARCH PARKWAY,
Mailing Address - Street 2:SUITE 370,
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-3611
Mailing Address - Country:US
Mailing Address - Phone:405-271-9025
Mailing Address - Fax:405-271-9026
Practice Address - Street 1:800 RESEARCH PARKWAY,
Practice Address - Street 2:SUITE 370,
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3611
Practice Address - Country:US
Practice Address - Phone:405-271-9025
Practice Address - Fax:405-271-9026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO177946OtherBLUECROSS BLUESHIELD
OK200043570AMedicaid
MO177946OtherBLUECROSS BLUESHIELD
OK400522154Medicare ID - Type Unspecified