Provider Demographics
NPI:1528000288
Name:RADIOLOGY CONSULTANTS, PC
Entity Type:Organization
Organization Name:RADIOLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BREKKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-286-0380
Mailing Address - Street 1:4200 W MEMORIAL RD STE 212
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8305
Mailing Address - Country:US
Mailing Address - Phone:405-242-2138
Mailing Address - Fax:405-286-0380
Practice Address - Street 1:4200 W MEMORIAL RD STE 212
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8305
Practice Address - Country:US
Practice Address - Phone:405-242-2138
Practice Address - Fax:405-286-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100729980AMedicaid
OK100729980AMedicaid