Basic Information
| Provider Information | |||||||||
| NPI: | 1356332688 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORMAN OPEN MRI, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1608 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730701608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059282530 | ||||||||
| FaxNumber: | 4059282950 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 N PORTER AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730716443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053641071 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 02/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | JENNINGS | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4059282530 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 200000060A | 05 | OK | MEDICAID |