Provider Demographics
NPI:1205084258
Name:RAINDANCER LLC DBA DOCTORS MRI
Entity type:Organization
Organization Name:RAINDANCER LLC DBA DOCTORS MRI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-354-1200
Mailing Address - Street 1:5366 N.W. CACHE RD. STE 4
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3335
Mailing Address - Country:US
Mailing Address - Phone:580-354-1200
Mailing Address - Fax:580-354-1202
Practice Address - Street 1:5366 NW CACHE RD STE 4
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3335
Practice Address - Country:US
Practice Address - Phone:580-531-1200
Practice Address - Fax:580-531-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
TXK30262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200215350AMedicaid
OK200215350AMedicaid