1427018324 NPI number — MIDWEST RADIOLOGY ASSOCIATES PC

Table of content: (NPI 1427018324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427018324 NPI number — MIDWEST RADIOLOGY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST RADIOLOGY ASSOCIATES PC
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:
1427018324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 720778
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73070-4602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-535-7669
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 PARKLAWN DR
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73110-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-610-8398
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEGNER
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
405-535-7669

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: 100735840A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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