MEDICARE: ADVANTAGE HOME MEDICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1235902388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE HOME MEDICAL

Provider Business Mailing Address
First Line	:	904 GRANDVIEW RD
Second Line	:
City	:	TUTTLE
State	:	OK
Zip	:	73089-8497
Country	:	US
Telephone Number	:	405-689-0433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-4930
Country	:	US
Telephone Number	:	405-689-0433
Fax Number	:

Authorized Official
Title or Position	:	APRN/OWNER
Name	:	MICHELE LYNNE LANGE
Credential	:	CNP
Telephone Number	:	405-689-0433

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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Directions to “ADVANTAGE HOME MEDICAL ” Practice Location

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