Provider Demographics
NPI:1538860234
Name:PREMIER BREAST HEALTH INSTITUTE OF OKLAHOMA LLC
Entity type:Organization
Organization Name:PREMIER BREAST HEALTH INSTITUTE OF OKLAHOMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-456-1117
Mailing Address - Street 1:8516 SOUTH PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159
Mailing Address - Country:US
Mailing Address - Phone:405-773-6700
Mailing Address - Fax:405-720-3910
Practice Address - Street 1:8516 SOUTH PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159
Practice Address - Country:US
Practice Address - Phone:405-773-6700
Practice Address - Fax:405-720-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty