Provider Demographics
NPI:1942244777
Name:UTICA SERVICES INC.
Entity Type:Organization
Organization Name:UTICA SERVICES INC.
Other - Org Name:REGIONAL RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO ST. JOHN HEALTH SYSTE
Authorized Official - Prefix:
Authorized Official - First Name:SR. M. THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTSCHALK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-744-2180
Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:DEPARTMENT 2296
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74182-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-744-2180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTICA SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731131608001OtherBCBS
OK093012353-001OtherBCBS
OK093011354-001OtherBCBS
OK=========-018OtherBCBS
OK093012353-001OtherBCBS
OK731131608001OtherBCBS
OK=========-016OtherBCBS