Provider Demographics
NPI:1447023817
Name:NORTHEAST OKLAHOMA RADIOLOGY PHYSICIANS PLLC
Entity type:Organization
Organization Name:NORTHEAST OKLAHOMA RADIOLOGY PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLBY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGIACOMO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-640-5600
Mailing Address - Street 1:1175 S ASPEN AVE STE K
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4800
Mailing Address - Country:US
Mailing Address - Phone:833-524-2400
Mailing Address - Fax:918-290-4943
Practice Address - Street 1:3500 E FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2411
Practice Address - Country:US
Practice Address - Phone:918-333-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty