Provider Demographics
NPI:1922023175
Name:SHILOH IMAGING CENTER LLC
Entity Type:Organization
Organization Name:SHILOH IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-928-9880
Mailing Address - Street 1:1415 N WATTS ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-1310
Mailing Address - Country:US
Mailing Address - Phone:580-928-9980
Mailing Address - Fax:
Practice Address - Street 1:1415 N WATTS ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-1310
Practice Address - Country:US
Practice Address - Phone:580-928-9980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========001OtherBLUE CROSS BLUE SHIELD