Provider Demographics
NPI:1720075112
Name:MORTON COMPREHENSIVE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:MORTON COMPREHENSIVE HEALTH SERVICES INC
Other - Org Name:MORTON COMPREHENSIVE HEALTH SERVICES INC X-RAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAUNYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-295-6107
Mailing Address - Street 1:1334 N LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-5907
Mailing Address - Country:US
Mailing Address - Phone:918-295-6137
Mailing Address - Fax:918-582-0529
Practice Address - Street 1:1334 N LANSING AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-5907
Practice Address - Country:US
Practice Address - Phone:918-295-6137
Practice Address - Fax:918-582-0529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-30
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371803OtherMEDICARE
OK37-1832OtherMEDICARE
OK37-1834OtherMEDICARE
OK371803OtherMEDICARE