Provider Demographics
NPI:1558944595
Name:ADVANTAGE IR NE LLC
Entity Type:Organization
Organization Name:ADVANTAGE IR NE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-481-7369
Mailing Address - Street 1:100 S MCCLINTOCK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4816
Mailing Address - Country:US
Mailing Address - Phone:602-481-7369
Mailing Address - Fax:
Practice Address - Street 1:10828 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2647
Practice Address - Country:US
Practice Address - Phone:480-937-2909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty