Provider Demographics
NPI:1588932560
Name:SOONER DIAGNOSTIC & NEURO TESTING
Entity type:Organization
Organization Name:SOONER DIAGNOSTIC & NEURO TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-994-4208
Mailing Address - Street 1:3081 W ALBANY ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1147
Mailing Address - Country:US
Mailing Address - Phone:918-994-4208
Mailing Address - Fax:918-994-4209
Practice Address - Street 1:3081 W ALBANY ST
Practice Address - Street 2:SUITE 111
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1147
Practice Address - Country:US
Practice Address - Phone:918-994-4208
Practice Address - Fax:918-994-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty