Provider Demographics
NPI:1609974849
Name:SOUTHWEST OKLAHOMA MRI, LLC
Entity Type:Organization
Organization Name:SOUTHWEST OKLAHOMA MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:KIMZEY
Authorized Official - Suffix:
Authorized Official - Credentials:BA RT(R)(MR)(CT),CRA
Authorized Official - Phone:405-691-8558
Mailing Address - Street 1:9901 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6920
Mailing Address - Country:US
Mailing Address - Phone:405-691-8558
Mailing Address - Fax:405-691-8913
Practice Address - Street 1:9901 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6920
Practice Address - Country:US
Practice Address - Phone:405-691-8558
Practice Address - Fax:405-691-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology