MEDICARE: OKLAHOMA HEART HOSPITAL 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	282N00000X	General Acute Care Hospital
2	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

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	:	1366680795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA HEART HOSPITAL LLC

Provider Business Mailing Address
First Line	:	4050 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8382
Country	:	US
Telephone Number	:	405-608-3300
Fax Number	:	405-608-1550

Provider Business Practice Location Address
First Line	:	530 SW 80TH ST
Second Line	:	IMAGING SOUTH
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9408
Country	:	US
Telephone Number	:	405-488-6170
Fax Number	:	405-608-1550

Authorized Official
Title or Position	:	CEO
Name	:	DR. JOHN HARVEY
Credential	:	MD
Telephone Number	:	405-608-3300

Provider Enumeration Date	:	01/22/2009
Last Update Date	:	07/10/2020

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