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OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC
NPI 1104291236
Dermatology - MOHS-Micrographic Surgery in Broken Arrow, OK

Active since December 01, 2015CLIA Certified · 3 labs
800 W BOISE CIR STE 400, BROKEN ARROW, OK 74012(918) 307-0215(918) 250-7669 Get Directions Write a Review

NPPES record last updated: August 11, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Aug 11, 2025, Feb 18, 2020, Dec 1, 2015 (3 updates tracked since 2015).

About Oklahoma Cancer Specialists And Research Institute Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC (NPI 1104291236) is a healthcare organization registered as a mohs-micrographic surgery in Broken Arrow, Oklahoma and active in the NPI registry since December 2015. The organization holds 3 active CLIA laboratory certificates and lists Daron G. Street, President, as its authorized official.

NPPES Registry Identity

NPI1104291236
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameOKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC
Location Address800 W BOISE CIR STE 400Broken Arrow, OK 74012-4974
Mailing Address12697 E 51st StTulsa, OK 74146-6236 · (918) 307-0215 · Fax (918) 250-7669
Phone(918) 307-0215
Fax(918) 250-7669
Organization SubpartNo
Authorized OfficialDaron G. StreetPresident · (918) 505-3200
Enumeration DateDecember 1, 2015
Last NPPES UpdateAugust 11, 20253 updates tracked since enumeration
NPPES CertifiedAugust 11, 2025
✔ NPI 1104291236 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
Definition

The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
800 W BOISE CIR STE 400, Broken Arrow, OK 74012
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 37D0859740

Oklahoma Cancer Specialist & Research Institute LLC · Tulsa, OK
Active · expires Dec 22, 2027
CLIA Number37D0859740
Laboratory TypePhysician Office
Certificate Effective DateDecember 23, 2025
Certificate Expiration DateDecember 22, 2027
Laboratory DirectorAdam Hoffhines
Laboratory Phone(918) 505-3200
Laboratory LocationOklahoma Cancer Specialist & Research Institute LLC12697 E 51st Street South, Tulsa, OK 74146
CLIA data matches this NPI record on: Address Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 37D1092968

Oklahoma Cancer Specialist & Research Institute LLC · Tulsa, OK
Active · expires Dec 7, 2026
CLIA Number37D1092968
Laboratory TypePhysician Office
Certificate Effective DateDecember 8, 2024
Certificate Expiration DateDecember 7, 2026
Laboratory DirectorMark R. Olsen
Laboratory Phone(918) 505-3200
Laboratory LocationOklahoma Cancer Specialist & Research Institute LLC12697 E 51st Street South, Tulsa, OK 74146
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 37D0681101

Oklahoma Cancer Specialist & Research Institute Skin Cancer Center · Broken Arrow, OK
Active · expires Mar 28, 2028
CLIA Number37D0681101
Laboratory TypePhysician Office
Certificate Effective DateMarch 29, 2026
Certificate Expiration DateMarch 28, 2028
Laboratory DirectorJanelle M. Pavlis
Laboratory Phone(918) 307-0215
Laboratory LocationOklahoma Cancer Specialist & Research Institute Skin Cancer Center800 W. Boise Circle, Suite 400, Broken Arrow, OK 74012
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JANELLE MARSHALL PAVLIS M.D.
Dermatology
800 W BOISE CIR STE 400
BROKEN ARROW, OK 74012
Tulsa County (918) 307-0215

Frequently Asked Questions

What is OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC's NPI number?

The NPI number assigned to this healthcare provider is 1104291236, enumerated as an "organization" on December 01, 2015.

Where is the provider located?

The provider is located at 800 W BOISE CIR STE 400 BROKEN ARROW, OK 74012 and the phone number is (918) 307-0215.

What is the provider's specialty?

Dermatology with taxonomy code 207ND0101X and a focus in MOHS-Micrographic Surgery.