Healthcare Provider Details

I. General information

NPI: 1528013448
Provider Name (Legal Business Name): YUKON MEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 GARTH BROOKS BLVD
YUKON OK
73099-6349
US

IV. Provider business mailing address

PO BOX 100 DEPT 403
BIXBY OK
74008-0100
US

V. Phone/Fax

Practice location:
  • Phone: 918-496-5000
  • Fax:
Mailing address:
  • Phone: 918-293-1700
  • Fax:

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: SETH CARNEY
Title or Position: VP OF OPERATIONS
Credential:
Phone: 918-496-5264