Provider Demographics
NPI:1215952023
Name:THE BREAST CENTER
Entity type:Organization
Organization Name:THE BREAST CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. CORP. DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-536-9729
Mailing Address - Street 1:5604 SW LEE BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9681
Mailing Address - Country:US
Mailing Address - Phone:580-536-9729
Mailing Address - Fax:580-536-2584
Practice Address - Street 1:5604 SW LEE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9681
Practice Address - Country:US
Practice Address - Phone:580-536-9729
Practice Address - Fax:580-536-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK141952261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK141952OtherFDA NUMBER