Provider Demographics
NPI:1447585302
Name:ARDMORE PET ASSOCIATES
Entity Type:Organization
Organization Name:ARDMORE PET ASSOCIATES
Other - Org Name:ARDMORE DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-221-0894
Mailing Address - Street 1:720 N COMMERCE ST
Mailing Address - Street 2:PMB 655
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3915
Mailing Address - Country:US
Mailing Address - Phone:580-223-7226
Mailing Address - Fax:580-223-7228
Practice Address - Street 1:908 N ROCKFORD RD
Practice Address - Street 2:SUITE C
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2540
Practice Address - Country:US
Practice Address - Phone:580-223-7226
Practice Address - Fax:580-223-7228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-11
Last Update Date:2009-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology