Healthcare Provider Details

I. General information

NPI: 1811646680
Provider Name (Legal Business Name): ZOOM DIAGNOSTIC IMAGING PONCA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 W CHERRY AVE
ENID OK
73703-3320
US

IV. Provider business mailing address

3508 SOUTHWESTERN BLVD
DALLAS TX
75225-7454
US

V. Phone/Fax

Practice location:
  • Phone: 580-540-3270
  • Fax:
Mailing address:
  • Phone: 214-504-6156
  • 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