Basic Information
| Provider Information | |||||||||
| NPI: | 1902091341 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RAMIC OKLAHOMA CITY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9654 N MAY AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731202714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057490074 | ||||||||
| FaxNumber: | 4057490062 | ||||||||
| Practice Location | |||||||||
| Address1: | 9654 N MAY AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731202714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057490074 | ||||||||
| FaxNumber: | 4057490062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 05/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | ISCH | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4057490074 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GENESIS MEDICAL IMAGING, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.