MEDICARE: CARDIOLOGY DIAGNOSTICES OF MUSKOGEE

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	OK-31060-01	OK

General Provider Information

NPI Number	:	1891741500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOLOGY DIAGNOSTICES OF MUSKOGEE

Provider Business Mailing Address
First Line	:	3338 W OKMULGEE ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-5069
Country	:	US
Telephone Number	:	918-681-6100
Fax Number	:	918-681-6112

Provider Business Practice Location Address
First Line	:	3338 W OKMULGEE ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-5069
Country	:	US
Telephone Number	:	918-681-6100
Fax Number	:	918-681-6112

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. GINA WALKER
Credential	:
Telephone Number	:	918-683-8100

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	02/11/2010

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