# PROVISION IMAGING OF FIRST STREET

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619991783
- **Authorized official:** ROBERT MATT TRENT (COO)
- **Authorized official phone:** (405) 842-7768

## Contact information

- **Practice address:** 4747 BELLAIRE BLVD, SUITE 101, BELLAIRE, TX 77401-4527
- **Practice address phone:** (713) 663-7672
- **Practice address fax:** (713) 663-7677
- **Mailing address:** 1601 NW EXPRESSWAY, SUITE 1300, OKLAHOMA CITY, OK 73118
- **Mailing address phone:** (405) 842-7768
- **Mailing address fax:** (405) 842-7789

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | R28949 | TX | Yes |

## Other

- **Enumeration date:** 07/26/2006
- **Last updated:** 08/22/2020