MEDICARE: SWOMRI, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	N/A	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	470001158	OTHER	OK	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1104870625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWOMRI, LLC

Provider Business Mailing Address
First Line	:	1044 SW 44TH ST
Second Line	:	SUITE 416 # JOHNNIE
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3609
Country	:	US
Telephone Number	:	405-632-4263
Fax Number	:	405-631-4820

Provider Business Practice Location Address
First Line	:	1044 SW 44TH ST
Second Line	:	SUITE 416 # JOHNNIE
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3609
Country	:	US
Telephone Number	:	405-632-4263
Fax Number	:	405-631-4820

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOEL L FRAZIER
Credential	:	MD
Telephone Number	:	405-609-6145

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/12/2012

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Directions to “SWOMRI, LLC ” Practice Location

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