Healthcare Provider Details

I. General information

NPI: 1588648679
Provider Name (Legal Business Name): NORTHERN OKLAHOMA DIAGNOSTIC IMAGING LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 W WILLOW SUITE D
ENID OK
73703
US

IV. Provider business mailing address

1204 W WILLOW SUITE D
ENID OK
73703
US

V. Phone/Fax

Practice location:
  • Phone: 405-775-4301
  • Fax: 405-841-9345
Mailing address:
  • Phone: 405-775-4301
  • Fax: 405-841-9354

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: MS. DEBRA Z NUSSBAUM
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 405-775-4227