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General NPI Number Information
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NPI Number | 1538345244
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Entity Type | Organization
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Legal Business Name | LIBERTY DIAGNOSTIC IMAGING OF OKC LLC
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4001 NW EXPRESSWAY ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-1686
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Country | US
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Telephone | 405-348-7676
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Fax | 405-348-9966
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Provider Business Mailing Address
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Address Line | 700 W 15TH ST STE 11
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City | EDMOND
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State | OK
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Zip | 73013-3749
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Country | US
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Telephone | 405-348-7676
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Fax | 405-348-9966
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT M TRENT
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Credential |
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Telephone | 405-348-7676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State | OK
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