Provider Demographics
NPI:1902850993
Name:ADVANCED IMAGING RESOURCES CO
Entity Type:Organization
Organization Name:ADVANCED IMAGING RESOURCES CO
Other - Org Name:SIR MAGNETIC IMAGING; SERVANT MEDICAL IMAGING OF OWASSO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-496-5264
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:DEPT 401
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-0100
Mailing Address - Country:US
Mailing Address - Phone:918-293-1752
Mailing Address - Fax:
Practice Address - Street 1:13616 E 103RD ST N
Practice Address - Street 2:SUITE C
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4586
Practice Address - Country:US
Practice Address - Phone:918-496-5264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========Medicare ID - Type Unspecified