Healthcare Provider Details

I. General information

NPI: 1023067857
Provider Name (Legal Business Name): POWERS RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT 814
TULSA OK
74182-0001
US

IV. Provider business mailing address

DEPARTMENT 814
TULSA OK
74182-0001
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-4378
  • Fax: 918-743-6542
Mailing address:
  • Phone: 918-748-4378
  • Fax: 918-743-6542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW G. POWERS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 918-748-4378