Provider Demographics
NPI:1528011681
Name:E PLUS PET IMAGING IV LP
Entity Type:Organization
Organization Name:E PLUS PET IMAGING IV LP
Other - Org Name:PET IMAGING OF OKLAHOMA CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO OF GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RHYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-467-7415
Mailing Address - Street 1:111 HARRISON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-1817
Mailing Address - Country:US
Mailing Address - Phone:405-272-5090
Mailing Address - Fax:405-272-5091
Practice Address - Street 1:111 HARRISON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-1817
Practice Address - Country:US
Practice Address - Phone:405-272-5090
Practice Address - Fax:405-272-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00073138OtherRRMEDICARE
OK200015780CMedicaid
800522283Medicare ID - Type Unspecified