MEDICARE: ZOOM DIAGNOSTIC IMAGING ARDMORE 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	:	1770116329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZOOM DIAGNOSTIC IMAGING ARDMORE LLC

Provider Business Mailing Address
First Line	:	1228 MERRICK DR
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1824
Country	:	US
Telephone Number	:	580-319-5091
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 MERRICK DR
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1824
Country	:	US
Telephone Number	:	580-540-3244
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID SAVAGE
Credential	:
Telephone Number	:	214-504-6156

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	05/11/2020

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