Basic Information
| Provider Information | |||||||||
| NPI: | 1154431310 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT FRANCIS BREAST CENTER MRI, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6161 S YALE AVE | ||||||||
| Address2: | XAVIER - B LEVEL | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741361902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184947365 | ||||||||
| FaxNumber: | 9184947239 | ||||||||
| Practice Location | |||||||||
| Address1: | 6475 S YALE AVE | ||||||||
| Address2: | SUITE 411 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741367816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184949270 | ||||||||
| FaxNumber: | 9185029523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHICK | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT, FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 9184947365 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | 2262 | OK | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
No ID Information.