Provider Demographics
NPI:1285626051
Name:PREMIER MRI OF TULSA, INC.
Entity Type:Organization
Organization Name:PREMIER MRI OF TULSA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-749-9980
Mailing Address - Street 1:3345 S HARVARD AVE
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1812
Mailing Address - Country:US
Mailing Address - Phone:918-749-9980
Mailing Address - Fax:
Practice Address - Street 1:3345 S HARVARD AVE
Practice Address - Street 2:SUITE 103A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1812
Practice Address - Country:US
Practice Address - Phone:918-749-9980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory