Healthcare Provider Details

I. General information

NPI: 1578703930
Provider Name (Legal Business Name): SOONER MOBILE X-RAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 W WILLOW AVE
DUNCAN OK
73533-4922
US

IV. Provider business mailing address

PO BOX 188
DUNCAN OK
73534-0188
US

V. Phone/Fax

Practice location:
  • Phone: 580-475-9729
  • Fax: 580-475-9728
Mailing address:
  • Phone: 580-475-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number237277
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: PAUL D SCOTT
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 580-475-9729