Provider Demographics
NPI:1790192599
Name:CALERA RADIOLOGY LLC
Entity Type:Organization
Organization Name:CALERA RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-443-3010
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:OK
Mailing Address - Zip Code:74730-0449
Mailing Address - Country:US
Mailing Address - Phone:580-434-6900
Mailing Address - Fax:580-434-6901
Practice Address - Street 1:213 E MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CALERA
Practice Address - State:OK
Practice Address - Zip Code:74730-2102
Practice Address - Country:US
Practice Address - Phone:580-434-6900
Practice Address - Fax:580-434-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK702290293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory