Provider Demographics
NPI:1588666473
Name:LAKEPOINTE PET, LLC
Entity Type:Organization
Organization Name:LAKEPOINTE PET, LLC
Other - Org Name:LAKEPOINTE IMAGING CENTER AND OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-488-7226
Mailing Address - Street 1:10914 HEFNER POINTE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5066
Mailing Address - Country:US
Mailing Address - Phone:405-488-7226
Mailing Address - Fax:405-418-0118
Practice Address - Street 1:10914 HEFNER POINTE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5066
Practice Address - Country:US
Practice Address - Phone:405-488-7226
Practice Address - Fax:405-418-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKN A261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology