Provider Demographics
NPI:1659311470
Name:RADIOLOGICAL SERVICES, INC
Entity Type:Organization
Organization Name:RADIOLOGICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-664-9892
Mailing Address - Street 1:PO BOX 1748
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-1748
Mailing Address - Country:US
Mailing Address - Phone:855-896-8451
Mailing Address - Fax:
Practice Address - Street 1:3500 E FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2411
Practice Address - Country:US
Practice Address - Phone:918-333-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100729150AMedicaid
KS100212370AMedicaid
KS110099Medicare PIN
OKCO1482Medicare PIN
KSDG0983Medicare PIN
OK=========Medicare PIN