Provider Demographics
NPI:1194704494
Name:MUSKOGEE PET AND NUCLEAR IMAGING
Entity type:Organization
Organization Name:MUSKOGEE PET AND NUCLEAR IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-686-7382
Mailing Address - Street 1:3300 CHANDLER RD
Mailing Address - Street 2:SUITE #106
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-4909
Mailing Address - Country:US
Mailing Address - Phone:918-686-7382
Mailing Address - Fax:918-686-7995
Practice Address - Street 1:3300 CHANDLER RD
Practice Address - Street 2:SUITE #106
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-4909
Practice Address - Country:US
Practice Address - Phone:918-686-7382
Practice Address - Fax:918-686-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========001OtherBLUE CROSS BLUE SHIELD