NPIMap

Organization Active NPI

Providence Radiology

  • Diagnostic Radiology Physician
  • Tulsa, OK
National Provider Identifier
1093771321
Registry record updated Oct 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PROVIDENCE RADIOLOGY
Practice address
4500 S Garnett Rd
Ste 919
Tulsa, OK 74146-5229
Phone
(918) 728-6145
NPI assigned
Apr 25, 2006
Last updated
Oct 15, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jim Bolene, MDNPI 1679530398
Title
President
Phone
(918) 728-6145

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

4500 S Garnett Rd
Ste 919
Tulsa, OK 74146-5229

Mailing address

4500 S Garnett Rd
Ste 919
Tulsa, OK 74146-5229
Phone (918) 728-6145

Other identifiers 1

IdentifierTypeStateIssuer
CG4619OtherRR MEDICARE

National Provider Directory

National Provider Directory

Locations

101 Rockefeller Dr
Muskogee, OK 74401
Phone (918) 683-1831

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1093771321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 S GARNETT RD",
            "address_2": "STE 919",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741465229",
            "telephone_number": "918-728-6145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 S GARNETT RD",
            "address_2": "STE 919",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741465229",
            "telephone_number": "918-728-6145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE RADIOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "BOLENE",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-728-6145",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CG4619",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.