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General NPI Number Information
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NPI Number | 1588845127
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Entity Type | Organization
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Legal Business Name | PCH RADIOLOGY PC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 1900 N 14TH ST DEPT OF RADIOLOGY
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City | PONCA CITY
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State | OK
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Zip | 74601-2035
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Country | US
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Telephone | 580-765-0575
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Fax | 580-765-0584
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Provider Business Mailing Address
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Address Line | 200 HANNA DR
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City | PONCA CITY
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State | OK
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Zip | 74604-5764
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Country | US
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Telephone | 321-698-3724
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD SCOTT ROSENBLUM
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Credential | DO
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Telephone | 321-698-3724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | OK
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