Provider Demographics
NPI:1811238918
Name:THE LAWTON IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:THE LAWTON IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-699-4373
Mailing Address - Street 1:1108 SW B AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4229
Mailing Address - Country:US
Mailing Address - Phone:580-699-7571
Mailing Address - Fax:580-699-7581
Practice Address - Street 1:1108 SW B AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4229
Practice Address - Country:US
Practice Address - Phone:580-699-7571
Practice Address - Fax:580-699-7581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology