Provider Demographics
NPI:1629859525
Name:ADVANCED MEDICAL PROVIDERS
Entity Type:Organization
Organization Name:ADVANCED MEDICAL PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARGIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:580-220-9830
Mailing Address - Street 1:13908 QUAILBROOK DR BLDG C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1718
Mailing Address - Country:US
Mailing Address - Phone:405-449-0276
Mailing Address - Fax:
Practice Address - Street 1:13908 QUAILBROOK DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1718
Practice Address - Country:US
Practice Address - Phone:405-449-0276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center