MEDICARE: OKLAHOMA RADIOLOGY GROUP P C

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	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841283165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA RADIOLOGY GROUP P C

Provider Business Mailing Address
First Line	:	5400 N GRAND BLVD STE 260
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5705
Country	:	US
Telephone Number	:	405-486-7250
Fax Number	:	706-653-8732

Provider Business Practice Location Address
First Line	:	5400 N GRAND BLVD STE 260
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5705
Country	:	US
Telephone Number	:	405-486-7250
Fax Number	:	706-653-8732

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHESTER W BEAM
Credential	:	MD
Telephone Number	:	405-486-7255

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	02/26/2024

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