Healthcare Provider Details

I. General information

NPI: 1548095920
Provider Name (Legal Business Name): PREFERRED DIAGNOSTIC IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 N COMMERCE ST STE C
ARDMORE OK
73401-1357
US

IV. Provider business mailing address

301 LILAC DR
EDMOND OK
73034-7297
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-7587
  • Fax: 580-226-4878
Mailing address:
  • Phone: 405-906-3375
  • Fax: 405-216-3743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BENT KEITH HOLLIMAN
Title or Position: MANAGER
Credential: PA
Phone: 405-227-1280