Healthcare Provider Details

I. General information

NPI: 1144511221
Provider Name (Legal Business Name): URBAN ADVANTAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12205 STRATFORD DR
OKLAHOMA CITY OK
73120-7801
US

IV. Provider business mailing address

12205 STRATFORD DR
OKLAHOMA CITY OK
73120-7801
US

V. Phone/Fax

Practice location:
  • Phone: 405-837-1065
  • Fax:
Mailing address:
  • Phone: 405-837-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: CARLOS WILLIAMS
Title or Position: CEO
Credential: BA, BHRS
Phone: 405-837-1065