Healthcare Provider Details

I. General information

NPI: 1457372492
Provider Name (Legal Business Name): OPENSIDED MRI OF OKLAHOMA CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 NW 56TH ST ST 105
OKLAHOMA CITY OK
73112-4517
US

IV. Provider business mailing address

3500 NW 56TH ST ST 105
OKLAHOMA CITY OK
73112-4517
US

V. Phone/Fax

Practice location:
  • Phone: 405-943-0055
  • Fax: 405-943-0078
Mailing address:
  • Phone: 405-943-0055
  • Fax: 405-943-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: LINDA RHODES
Title or Position: OFFICER TREASURER
Credential:
Phone: 804-217-7114