Healthcare Provider Details

I. General information

NPI: 1841071537
Provider Name (Legal Business Name): INSIGHT DIAGNOSTICS GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 04/29/2024
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14017 N EASTERN AVE
EDMOND OK
73013-5586
US

IV. Provider business mailing address

14017 N EASTERN AVE
EDMOND OK
73013-5586
US

V. Phone/Fax

Practice location:
  • Phone: 405-478-5333
  • Fax: 405-478-5334
Mailing address:
  • Phone: 405-478-5333
  • Fax: 405-478-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JEFF COURCIER
Title or Position: OWNER
Credential: PT
Phone: 405-478-5333