Provider Demographics
NPI:1437826310
Name:ADVANTAGE DIAGNOSTIC & MRI, LLC
Entity Type:Organization
Organization Name:ADVANTAGE DIAGNOSTIC & MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-499-9200
Mailing Address - Street 1:9014 S YALE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3509
Mailing Address - Country:US
Mailing Address - Phone:918-499-9200
Mailing Address - Fax:918-499-9300
Practice Address - Street 1:7703 N OWASSO EXPY STE 15
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3311
Practice Address - Country:US
Practice Address - Phone:918-272-9200
Practice Address - Fax:918-274-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)