Provider Demographics
NPI:1780329961
Name:ADVANTAGE DIAGNOSTICS & MRI LLC
Entity type:Organization
Organization Name:ADVANTAGE DIAGNOSTICS & MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:TAYLOR
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 1:2601 N ASPEN AVE STE 1015
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1375
Practice Address - Country:US
Practice Address - Phone:918-940-9200
Practice Address - Fax:918-940-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology