Healthcare Provider Details

I. General information

NPI: 1407817521
Provider Name (Legal Business Name): LAKEPOINTE PET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10914 HEFNER POINTE DR SUITE 100
OKLAHOMA CITY OK
73120-5066
US

IV. Provider business mailing address

PO BOX 1998
OKLAHOMA CITY OK
73101-1998
US

V. Phone/Fax

Practice location:
  • Phone: 405-488-7226
  • Fax: 405-418-0188
Mailing address:
  • Phone: 405-488-7226
  • Fax: 405-418-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES TAYLOR
Title or Position: VICE-PRESIDENT
Credential:
Phone: 405-488-7226