Provider Demographics
NPI:1538345244
Name:LIBERTY DIAGNOSTIC IMAGING OF OKC LLC
Entity type:Organization
Organization Name:LIBERTY DIAGNOSTIC IMAGING OF OKC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-348-7676
Mailing Address - Street 1:700 W 15TH ST STE 11
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3749
Mailing Address - Country:US
Mailing Address - Phone:405-348-7676
Mailing Address - Fax:405-348-9966
Practice Address - Street 1:4001 NW EXPRESSWAY ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1686
Practice Address - Country:US
Practice Address - Phone:405-348-7676
Practice Address - Fax:405-348-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)