Provider Demographics
NPI:1427049956
Name:DIAGNOSTIC IMAGING ASSOCIATES INC
Entity type:Organization
Organization Name:DIAGNOSTIC IMAGING ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VON BORSTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-935-3550
Mailing Address - Street 1:4500 S GARNETT RD STE 112
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5201
Mailing Address - Country:US
Mailing Address - Phone:918-935-3550
Mailing Address - Fax:918-935-3581
Practice Address - Street 1:744 W 9TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9020
Practice Address - Country:US
Practice Address - Phone:918-935-3550
Practice Address - Fax:918-935-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100729830AMedicaid
OKWCDCD1Medicare PIN
OKWCDCD1Medicare Oscar/Certification
OKCO1498Medicare PIN