Provider Demographics
NPI:1235902388
Name:ADVANTAGE HOME MEDICAL
Entity Type:Organization
Organization Name:ADVANTAGE HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:405-689-0433
Mailing Address - Street 1:904 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-8497
Mailing Address - Country:US
Mailing Address - Phone:405-689-0433
Mailing Address - Fax:
Practice Address - Street 1:1514 SW 119TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-4930
Practice Address - Country:US
Practice Address - Phone:405-689-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care