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General NPI Number Information
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NPI Number | 1508998808
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Entity Type | Organization
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Legal Business Name | PK XRAY INC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 347 S 37TH ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-4906
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Country | US
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Telephone | 918-683-9729
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Fax | 918-683-1012
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Provider Business Mailing Address
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Address Line | 347 S 37TH ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-4906
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Country | US
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Telephone | 918-683-9729
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Fax | 918-683-1012
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PHILLIP LEE KIZZIA
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Credential |
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Telephone | 918-683-9729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 701503
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License Number State | OK
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