Provider Demographics
NPI:1275837379
Name:SPECTRUM IMAGING PLLC
Entity Type:Organization
Organization Name:SPECTRUM IMAGING PLLC
Other - Org Name:IMAGING SERVICES OF OKLAHOMA PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRETHEWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-486-7250
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPT 130
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:405-486-7250
Mailing Address - Fax:706-653-1567
Practice Address - Street 1:300 ROCKEFELLER DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5075
Practice Address - Country:US
Practice Address - Phone:918-684-2189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty