Healthcare Provider Details

I. General information

NPI: 1366680795
Provider Name (Legal Business Name): OKLAHOMA HEART HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 SW 80TH ST IMAGING SOUTH
OKLAHOMA CITY OK
73139-9408
US

IV. Provider business mailing address

4050 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8382
US

V. Phone/Fax

Practice location:
  • Phone: 405-488-6170
  • Fax: 405-608-1550
Mailing address:
  • Phone: 405-608-3300
  • Fax: 405-608-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN HARVEY
Title or Position: CEO
Credential: MD
Phone: 405-608-3300