Organization
PONCA CITY OPEN MRI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLINTON LOCKE (EXECUTIVE DIRECTOR)
(580) 762-6740
Entity
Organization
Contact information
Practice address
2112 N 14TH ST, PONCA CITY, OK 74601-1829
(580) 762-6740
(580) 762-9627
Mailing address
2112 N 14TH ST, PONCA CITY, OK 74601-1829
(580) 762-6740
(580) 762-9627
Taxonomy
Speciality
Code
Description
License number
State
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100836750A
—
OK
05
—
7187533301
—
KS
Enumeration date
12/22/2005
Last updated
02/01/2011
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