Organization
SOUTHEASTERN RADIOLOGY P.C.
Active
Organization
SOUTHEASTERN RADIOLOGY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP MALONE (ADMINISTRATIVE MANGER)
(405) 321-8125
Entity
Organization
Contact information
Practice address
1 E CLARK BASS BLVD, MCALESTER, OK 74501-4209
(918) 423-3602
Mailing address
PO BOX 758, MCALESTER, OK 74502-0758
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100746920A
—
OK
Enumeration date
11/22/2005
Last updated
06/02/2008
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