37D2064294 CLIA NUMBER - OSU MEDICINE - RIVERSIDE

Laboratory Demographics

  • CLIA Code: 37D2064294
  • Facility Name: OSU MEDICINE - RIVERSIDE
  • Facility Address: 9645 RIVERSIDE PARKWAY STE C
    TULSA, OK
    ZIP 74137
  • Facility Phone: 918 209-5170
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HALLIE FREDERICK
  • NPI Number: 1407390115
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 37D2064294
LAB Type Physician Office
Facility Name OSU MEDICINE - RIVERSIDE
Street 9645 RIVERSIDE PARKWAY STE C
City TULSA
State OK
ZIP 74137
Phone 918 209-5170
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2025
Certificate Expiration Date 8/16/2027
Facility Type Physician Office
Lab Director HALLIE FREDERICK

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This page was last updated on: 9/29/2025