MEDICARE: PREMIER MRI OF TULSA, INC.

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1285626051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER MRI OF TULSA, INC.

Provider Business Mailing Address
First Line	:	3345 S HARVARD AVE
Second Line	:	SUITE 103A
City	:	TULSA
State	:	OK
Zip	:	74135-1812
Country	:	US
Telephone Number	:	918-749-9980
Fax Number	:

Provider Business Practice Location Address
First Line	:	3345 S HARVARD AVE
Second Line	:	SUITE 103A
City	:	TULSA
State	:	OK
Zip	:	74135-1812
Country	:	US
Telephone Number	:	918-749-9980
Fax Number	:

Authorized Official
Title or Position	:	FACILITY MANAGER
Name	:	RITA KIRKENDALL
Credential	:
Telephone Number	:	918-749-9980

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	08/22/2020

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