MEDICARE: OPENSIDED MRI OF OKLAHOMA CITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist

General Provider Information

NPI Number	:	1457372492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPENSIDED MRI OF OKLAHOMA CITY LLC

Provider Business Mailing Address
First Line	:	3500 NW 56TH ST
Second Line	:	ST 105
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4517
Country	:	US
Telephone Number	:	405-943-0055
Fax Number	:	405-943-0078

Provider Business Practice Location Address
First Line	:	3500 NW 56TH ST
Second Line	:	ST 105
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4517
Country	:	US
Telephone Number	:	405-943-0055
Fax Number	:	405-943-0078

Authorized Official
Title or Position	:	OFFICER TREASURER
Name	:	LINDA RHODES
Credential	:
Telephone Number	:	804-217-7114

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	08/22/2020

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