MEDICARE: ULTRA HEALTH LLC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1922469543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRA HEALTH LLC

Provider Business Mailing Address
First Line	:	PO BOX 269084
Second Line	:	DEPT 1102
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4128 OLD JACKSON RD
Second Line	:
City	:	BELLS
State	:	TN
Zip	:	38006-4261
Country	:	US
Telephone Number	:	731-394-1145
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. CHARLES RICHARD JERMAN III
Credential	:
Telephone Number	:	731-234-8120

Provider Enumeration Date	:	03/09/2016
Last Update Date	:	05/23/2025

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Directions to “ULTRA HEALTH LLC ” Practice Location

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