Healthcare Provider Details

I. General information

NPI: 1770116329
Provider Name (Legal Business Name): ZOOM DIAGNOSTIC IMAGING ARDMORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 MERRICK DR
ARDMORE OK
73401-1824
US

IV. Provider business mailing address

1228 MERRICK DR
ARDMORE OK
73401-1824
US

V. Phone/Fax

Practice location:
  • Phone: 580-540-3244
  • Fax:
Mailing address:
  • Phone: 580-319-5091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID SAVAGE
Title or Position: OWNER
Credential:
Phone: 214-504-6156