Provider Demographics
NPI:1629020995
Name:MUSCULOSKELETAL IMAGING AND INTERVENTIONAL LLC
Entity Type:Organization
Organization Name:MUSCULOSKELETAL IMAGING AND INTERVENTIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-601-2325
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-1390
Mailing Address - Country:US
Mailing Address - Phone:405-601-2325
Mailing Address - Fax:405-497-6074
Practice Address - Street 1:1023 WATERWOOD PKWY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5324
Practice Address - Country:US
Practice Address - Phone:405-601-2325
Practice Address - Fax:405-497-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200069440AMedicaid
DF5072Medicare PIN
OK300522227Medicare PIN