Healthcare Provider Details

I. General information

NPI: 1689611303
Provider Name (Legal Business Name): MIDWEST OPEN MRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S DOUGLAS BLVD
MIDWEST CITY OK
73130-7114
US

IV. Provider business mailing address

1044 SW 44TH ST SUITE 600
OKLAHOMA CITY OK
73109-3609
US

V. Phone/Fax

Practice location:
  • Phone: 405-736-9222
  • Fax: 405-736-9144
Mailing address:
  • Phone: 405-631-4263
  • Fax: 405-631-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberN/A
License Number StateOK

VIII. Authorized Official

Name: DENNY OREB
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 405-609-6146