1427479435 NPI number — SONATA DIAGNOSTIC IMAGING, LLC

Table of content: (NPI 1427479435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427479435 NPI number — SONATA DIAGNOSTIC IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SONATA DIAGNOSTIC IMAGING, LLC
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:
6
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:
1427479435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3575
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73083-3575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-285-2581
Provider Business Mailing Address Fax Number:
405-330-1725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 S COLTRANE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73034-6733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-285-2581
Provider Business Practice Location Address Fax Number:
405-330-1725
Provider Enumeration Date:
12/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BORGERT
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
405-285-2581

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X , with the licence number:  1295895282 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200588140A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com