=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154431310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAINT FRANCIS BREAST CENTER MRI, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6475 S YALE AVE SUITE 411
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-7816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-494-9270
-----------------------------------------------------
Fax | 918-502-9523
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6161 S YALE AVE XAVIER - B LEVEL
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-494-7365
-----------------------------------------------------
Fax | 918-494-7239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE-PRESIDENT, FINANCIAL SERVICES
-----------------------------------------------------
Name | MR. ERIC E SCHICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-494-7365
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number | 2262
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------