Organization
VANTAGE OPEN MRI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY WAYNE WICKERSHAM (VP OF OPERATIONS)
(405) 418-0900
Entity
Organization
Contact information
Practice address
3400 W HEFNER RD, OKLAHOMA CITY, OK 73120-5083
(405) 418-0900
(405) 418-0901
Mailing address
3400 W HEFNER RD, OKLAHOMA CITY, OK 73120-5083
(405) 418-0900
(405) 418-0901
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
OK
Other
Enumeration date
07/02/2006
Last updated
04/20/2012
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