Healthcare Provider Details

I. General information

NPI: 1043467723
Provider Name (Legal Business Name): BREAST CANCER SCREENING CENTER OF OKLAHOMA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 WATERFORD BLVD STE 100
OKLAHOMA CITY OK
73118-1117
US

IV. Provider business mailing address

6307 WATERFORD BLVD STE 100
OKLAHOMA CITY OK
73118-1117
US

V. Phone/Fax

Practice location:
  • Phone: 405-607-6359
  • Fax: 405-235-8639
Mailing address:
  • Phone: 405-607-6359
  • Fax: 405-235-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9202
License Number StateOK

VIII. Authorized Official

Name: JOANN HABERMAN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 405-607-6359