MEDICARE: NORMAN OPEN MRI, 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	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356332688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORMAN OPEN MRI, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1608
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-1608
Country	:	US
Telephone Number	:	405-928-2530
Fax Number	:	405-928-2950

Provider Business Practice Location Address
First Line	:	1125 N PORTER AVE
Second Line	:	SUITE 100
City	:	NORMAN
State	:	OK
Zip	:	73071-6443
Country	:	US
Telephone Number	:	405-364-1071
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	DEBRA JENNINGS
Credential	:
Telephone Number	:	405-928-2530

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	02/01/2012

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