Healthcare Provider Details

I. General information

NPI: 1538345244
Provider Name (Legal Business Name): LIBERTY DIAGNOSTIC IMAGING OF OKC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 NW EXPRESSWAY ST
OKLAHOMA CITY OK
73116-1686
US

IV. Provider business mailing address

700 W 15TH ST STE 11
EDMOND OK
73013-3749
US

V. Phone/Fax

Practice location:
  • Phone: 405-348-7676
  • Fax: 405-348-9966
Mailing address:
  • Phone: 405-348-7676
  • Fax: 405-348-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROBERT M TRENT
Title or Position: OWNER
Credential:
Phone: 405-348-7676