Provider Demographics
NPI:1659479160
Name:OKLAHOMA MOBILE XRAY INC
Entity Type:Organization
Organization Name:OKLAHOMA MOBILE XRAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-475-0175
Mailing Address - Street 1:3011 N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-8923
Mailing Address - Country:US
Mailing Address - Phone:580-475-0175
Mailing Address - Fax:580-475-0190
Practice Address - Street 1:3011 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-8923
Practice Address - Country:US
Practice Address - Phone:580-475-0175
Practice Address - Fax:580-475-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========Medicare PIN