Provider Demographics
NPI:1730584509
Name:DIGITAL DIAGNOSTIC SOLUTIONS LLC
Entity type:Organization
Organization Name:DIGITAL DIAGNOSTIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:LADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-269-1085
Mailing Address - Street 1:6620 E 117TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-8204
Mailing Address - Country:US
Mailing Address - Phone:918-269-1085
Mailing Address - Fax:918-299-6520
Practice Address - Street 1:5017 S FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-8976
Practice Address - Country:US
Practice Address - Phone:918-269-1085
Practice Address - Fax:918-299-6520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty