Provider Demographics
NPI:1326024571
Name:OKLAHOMA DIAGNOSTIC IMAGING LTD
Entity Type:Organization
Organization Name:OKLAHOMA DIAGNOSTIC IMAGING LTD
Other - Org Name:OKLAHOMA DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:NUSSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-775-4227
Mailing Address - Street 1:236 NW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7422
Mailing Address - Country:US
Mailing Address - Phone:405-775-4301
Mailing Address - Fax:405-841-9345
Practice Address - Street 1:236 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7422
Practice Address - Country:US
Practice Address - Phone:405-843-0520
Practice Address - Fax:405-840-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200038800AMedicaid
OK=========Medicare ID - Type Unspecified