Provider Demographics
NPI:1609911452
Name:STILLWATER RADIOLOGY LLC
Entity Type:Organization
Organization Name:STILLWATER RADIOLOGY LLC
Other - Org Name:STILLWATER RADIOLOGY LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-743-0550
Mailing Address - Street 1:4721 W 6TH AVENUE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1549
Mailing Address - Country:US
Mailing Address - Phone:405-743-0550
Mailing Address - Fax:405-743-1704
Practice Address - Street 1:4721 W 6TH AVENUE
Practice Address - Street 2:SUITE 130
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1549
Practice Address - Country:US
Practice Address - Phone:405-743-0550
Practice Address - Fax:405-743-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty