1134432040 NPI number — RADIOLOGY ASSOCIATES OF EASTERN OKLAHOMA PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134432040 NPI number — RADIOLOGY ASSOCIATES OF EASTERN OKLAHOMA PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY ASSOCIATES OF EASTERN OKLAHOMA PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134432040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3330 NW 56TH
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73112-4426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-945-4710
Provider Business Mailing Address Fax Number:
405-562-9242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3330 NW 56TH ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73112-4479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-945-4710
Provider Business Practice Location Address Fax Number:
405-562-9242
Provider Enumeration Date:
07/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
405-945-4741

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200332530A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: DR7722 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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