1902850993 NPI number — ADVANCED IMAGING RESOURCES CO

Table of content: (NPI 1902850993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902850993 NPI number — ADVANCED IMAGING RESOURCES CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED IMAGING RESOURCES CO
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:
SIR MAGNETIC IMAGING; SERVANT MEDICAL IMAGING OF OWASSO
Provider Other Organization Name Type Code:
3
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:
1902850993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100
Provider Second Line Business Mailing Address:
DEPT 401
Provider Business Mailing Address City Name:
BIXBY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74008-0100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-293-1752
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13616 E 103RD ST N
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
OWASSO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74055-4586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-496-5264
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARNEY
Authorized Official First Name:
SETH
Authorized Official Middle Name:
Authorized Official Title or Position:
VP BUSINESS SERVICES
Authorized Official Telephone Number:
918-496-5264

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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