Provider Demographics
NPI:1922044841
Name:ADA MRI ASSOCIATES, L.L.C.
Entity Type:Organization
Organization Name:ADA MRI ASSOCIATES, L.L.C.
Other - Org Name:ADA OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WICKERSHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-418-2200
Mailing Address - Street 1:435 N MONTE VISTA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4609
Mailing Address - Country:US
Mailing Address - Phone:580-332-0400
Mailing Address - Fax:580-332-4269
Practice Address - Street 1:435 N MONTE VISTA ST
Practice Address - Street 2:SUITE B
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4609
Practice Address - Country:US
Practice Address - Phone:580-332-0400
Practice Address - Fax:580-332-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)