Organization
PROVIDENCE MRI ASSOCIATES
Active
Organization
PROVIDENCE MRI ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM BOLENE MD (PRESIDENT)
(918) 728-6145
Entity
Organization
Contact information
Practice address
4500 S GARNETT RD, STE 919, TULSA, OK 74146-5229
(918) 728-6145
Mailing address
4500 S GARNETT RD, STE 919, TULSA, OK 74146-5229
(918) 728-6145
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK2507
RR MEDICARE
—
Enumeration date
04/25/2006
Last updated
10/15/2007
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