Organization Name: | CALERA RADIOLOGY LLC |
NPI Number: | 1790192599 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SABRE WEATHERS (OWNER) |
Mailing Address: | 213 E Main St Calera |
State: | OK US |
Postal Code: | 747302102 |
Phone Number: | 5804346800 |
Fax Number: | 5804346801 |
NPI Enumeration Date: | 07/14/2014 |
NPI Last Update Date: | 07/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Radiology |
Taxonomy Definition: |