Organization
RADIOLOGY SERVICES OF ARDMORE, INC.
Active
Other names
RSA
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE DIBRELL-GARCIA (MANAGER)
(479) 452-9419
Entity
Organization
Contact information
Practice address
1011 14TH AVE NW, ARDMORE, OK 73401-1828
(479) 452-9416
(479) 484-0827
Mailing address
PO BOX 518, ARDMORE, OK 73402-0518
(479) 452-9416
(479) 484-0827
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
—
OK
2085R0202X
Diagnostic Radiology Physician
Primary
—
OK
2085U0001X
Diagnostic Ultrasound Physician
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100730410A
—
OK
Enumeration date
09/14/2006
Last updated
07/17/2020
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