Provider Demographics
NPI:1295829455
Name:MERCY HOSPITAL OKLAHOMA CITY, INC.
Entity Type:Organization
Organization Name:MERCY HOSPITAL OKLAHOMA CITY, INC.
Other - Org Name:RADIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:VITIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-752-3724
Mailing Address - Street 1:4300 W MEMORIAL RD
Mailing Address - Street 2:ATTN: JONATHAN R. VITIELLO
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8304
Mailing Address - Country:US
Mailing Address - Phone:405-752-3724
Mailing Address - Fax:
Practice Address - Street 1:4300 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8304
Practice Address - Country:US
Practice Address - Phone:405-755-1515
Practice Address - Fax:405-752-3811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL OKLAHOMA CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522063Medicare PIN