Provider Demographics
NPI:1891741500
Name:CARDIOLOGY DIAGNOSTICES OF MUSKOGEE
Entity Type:Organization
Organization Name:CARDIOLOGY DIAGNOSTICES OF MUSKOGEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-683-8100
Mailing Address - Street 1:3338 W OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5069
Mailing Address - Country:US
Mailing Address - Phone:918-681-6100
Mailing Address - Fax:918-681-6112
Practice Address - Street 1:3338 W OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5069
Practice Address - Country:US
Practice Address - Phone:918-681-6100
Practice Address - Fax:918-681-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK-31060-01293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522516Medicare PIN