Healthcare Provider Details

I. General information

NPI: 1316382930
Provider Name (Legal Business Name): NORMAN REGIONAL HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N PORTER AVE
NORMAN OK
73071-6404
US

IV. Provider business mailing address

1201 TORREY PINES RD
NORMAN OK
73072-2027
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-1600
  • Fax:
Mailing address:
  • Phone: 405-343-6341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number415881
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number11OK1439
License Number StateOK

VIII. Authorized Official

Name: MATTHEW PODANY
Title or Position: RADIOLOGY PRACTITIONER ASSISTANT
Credential: B.S.R.T., CBRPA
Phone: 405-343-6341