Provider Demographics
NPI:1801621263
Name:TRI STATE TOXICOLOGY
Entity type:Organization
Organization Name:TRI STATE TOXICOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-226-1020
Mailing Address - Street 1:611 W CHEROKEE ST STE C
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-4618
Mailing Address - Country:US
Mailing Address - Phone:918-226-1020
Mailing Address - Fax:
Practice Address - Street 1:611 W CHEROKEE ST STE C
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-4618
Practice Address - Country:US
Practice Address - Phone:918-226-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory