MEDICARE: COMPREHENSIVE DIAGNOSTIC IMAGING, 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1962768143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE DIAGNOSTIC IMAGING, LLC

Provider Business Mailing Address
First Line	:	5800 NORTH PORTLAND AVENUE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112
Country	:	US
Telephone Number	:	405-601-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 NORTH PORTLAND AVENUE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112
Country	:	US
Telephone Number	:	405-601-4500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAURIE JILL HAST
Credential	:	M.D,
Telephone Number	:	405-255-4518

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	04/02/2012

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