Organization
PROVISION IMAGING OF LAKE COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MATT TRENT (COO)
(405) 842-7768
Entity
Organization
Contact information
Practice address
7511 FREDLE DR, PAINESVILLE, OH 44077-9406
(440) 354-3686
(440) 354-6708
Mailing address
1601 NW EXPRESSWAY, SUITE 1300, OKLAHOMA CITY, OK 73118
(405) 842-7768
(405) 842-7789
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
07/26/2006
Last updated
08/22/2020
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