Provider Demographics
NPI:1376534693
Name:CT CENTER OF NORMAN LLC
Entity Type:Organization
Organization Name:CT CENTER OF NORMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-321-8125
Mailing Address - Street 1:PO BOX 1369
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1125 N PORTER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6443
Practice Address - Country:US
Practice Address - Phone:405-895-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100748930AMedicaid
OK100748930AMedicaid
OK400522139Medicare PIN