Healthcare Provider Details

I. General information

NPI: 1710102728
Provider Name (Legal Business Name): TCH RADIOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E DOWNING ST
TAHLEQUAH OK
74464-3324
US

IV. Provider business mailing address

800 ROCKMEAD DR 210
KINGWOOD TX
77339-2112
US

V. Phone/Fax

Practice location:
  • Phone: 281-359-7788
  • Fax: 281-359-7888
Mailing address:
  • Phone: 281-359-7788
  • Fax: 281-359-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200115290 A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name: JEFFREY KRANTZ
Title or Position: MEMBER
Credential: D.O.
Phone: 281-359-7788