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Organization
SOUTHEAST IMAGING, LLC
Active
Organization
SOUTHEAST IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMIAH AARON JANSEN M.D. (MEMBER)
(405) 249-7672
Entity
Organization
Contact information
Practice address
111 FOREST AVE., SUITE C, EUFAULA, OK 74432
(405) 945-4710
(405) 945-4751
Mailing address
3330 NW 56TH ST., SUITE 206, OKLAHOMA CITY, OK 73112
(405) 945-4710
(405) 945-4751
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
OK
293D00000X
Physiological Laboratory
—
—
Other
Enumeration date
07/13/2017
Last updated
11/27/2017
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