Organization
OKLAHOMA PET CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE N CHACKO MD (PRESIDENT)
(405) 604-4439
Entity
Organization
Contact information
Practice address
5401 N PORTLAND AVE, 330, OKLAHOMA CITY, OK 73112-2121
(405) 604-4439
Mailing address
5401 N PORTLAND AVE, 330, OKLAHOMA CITY, OK 73112-2121
(405) 604-4439
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
569959716001
BCBS
OK
Enumeration date
01/17/2008
Last updated
01/17/2008
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