Organization
PK XRAY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP LEE KIZZIA (PRESIDENT)
(918) 683-9729
Entity
Organization
Contact information
Practice address
347 S 37TH ST, MUSKOGEE, OK 74401-4906
(918) 683-9729
(918) 683-1012
Mailing address
347 S 37TH ST, MUSKOGEE, OK 74401-4906
(918) 683-9729
(918) 683-1012
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
701503
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165224710
—
AR
05
—
200038030B
—
OK
Enumeration date
03/12/2007
Last updated
07/18/2011
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