Provider Demographics
NPI:1558465617
Name:MED-CORP PLUS, INC.
Entity Type:Organization
Organization Name:MED-CORP PLUS, INC.
Other - Org Name:MOBILE DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:EZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-687-8033
Mailing Address - Street 1:3310 CHANDLER RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-4906
Mailing Address - Country:US
Mailing Address - Phone:918-687-8033
Mailing Address - Fax:918-687-4092
Practice Address - Street 1:1338 W SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-3406
Practice Address - Country:US
Practice Address - Phone:918-687-3297
Practice Address - Fax:918-687-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR19817Medicare ID - Type Unspecified