MEDICARE: SOUTHWEST OKLAHOMA MRI, 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1609974849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST OKLAHOMA MRI, LLC

Provider Business Mailing Address
First Line	:	9901 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6920
Country	:	US
Telephone Number	:	405-691-8558
Fax Number	:	405-691-8913

Provider Business Practice Location Address
First Line	:	9901 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6920
Country	:	US
Telephone Number	:	405-691-8558
Fax Number	:	405-691-8913

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL TODD KIMZEY
Credential	:	BA RT(R)(MR)(CT),CRA
Telephone Number	:	405-691-8558

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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