Provider Demographics
NPI:1841283165
Name:OKLAHOMA RADIOLOGY GROUP P C
Entity type:Organization
Organization Name:OKLAHOMA RADIOLOGY GROUP P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-486-7255
Mailing Address - Street 1:5400 N GRAND BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5705
Mailing Address - Country:US
Mailing Address - Phone:405-486-7250
Mailing Address - Fax:706-653-8732
Practice Address - Street 1:5400 N GRAND BLVD STE 260
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5705
Practice Address - Country:US
Practice Address - Phone:405-486-7250
Practice Address - Fax:706-653-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100729120AMedicaid