Providence Radiology

LBN: Providence Radiology
Providence Radiology is an health care organization with primary practice located at 4500 S Garnett Rd Ste 919, Tulsa OK 74146-5229. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as the primary health care specialty. Providence Radiology can be contacted via phone (918) 728-6145, or through Bolene, Jim via phone (918) 728-6145.

Contact Information

Primary practice address
4500 S Garnett Rd Ste 919 Tulsa OK 74146-5229
Phone: (918) 728-6145
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Bolene, Jim Doctor of Medicine (MD)
Phone: (918) 728-6145

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X

Profile Details

NPI number 1093771321
LBN Legal business name Providence Radiology
DBA Doing business as
Authorized official Bolene, Jim Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 25th, 2006
Last updated Oct 15th, 2007 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093771321 NPPES
Other CG4619 RR MEDICARE

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