Provider Demographics
NPI:1124637574
Name:QUALITY MEDICAL IMAGING OF OKLAHOMA, INC.
Entity type:Organization
Organization Name:QUALITY MEDICAL IMAGING OF OKLAHOMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:FASELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-839-1133
Mailing Address - Street 1:2490 PROFESSIONAL CT STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0835
Mailing Address - Country:US
Mailing Address - Phone:702-839-1133
Mailing Address - Fax:
Practice Address - Street 1:201 SHADY CREEK RD STE 115
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2412
Practice Address - Country:US
Practice Address - Phone:580-634-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier