Healthcare Provider Details

I. General information

NPI: 1922313972
Provider Name (Legal Business Name): CLEAR FOCUS CV ULTRASOUND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2010
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 OAK
ARDMORE OK
73401-3830
US

IV. Provider business mailing address

POST OFFICE BOX 1702
ARDMORE OK
73401-3830
US

V. Phone/Fax

Practice location:
  • Phone: 580-504-2430
  • Fax: 866-716-3820
Mailing address:
  • Phone: 580-504-2430
  • Fax: 866-716-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number32685
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number13089820-003-WTH
License Number StateUT

VIII. Authorized Official

Name: JIMMY A JEFFCOATS
Title or Position: PRESIDENT/CEO/CHIEF TECHNOLOGIST
Credential: RDCS
Phone: 580-504-2430