Provider Demographics
NPI:1063512275
Name:TULSA DIAGNOSTIC IMAGING
Entity Type:Organization
Organization Name:TULSA DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BAMBI
Authorized Official - Middle Name:BARBARAANN
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-499-1674
Mailing Address - Street 1:PO BOX 54194
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74155-0194
Mailing Address - Country:US
Mailing Address - Phone:918-499-1674
Mailing Address - Fax:918-499-1675
Practice Address - Street 1:6046 SOUTH SHERIDAN ROAD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145
Practice Address - Country:US
Practice Address - Phone:918-499-1674
Practice Address - Fax:918-499-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20003777AMedicaid
P00276821OtherRAILROAD MEDICARE
P00276821OtherRAILROAD MEDICARE