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NPI Code Detail

MEDICARE: AVANT DIABETTES MANAGEMENT LLC

MEDICARE: AVANT DIABETTES MANAGEMENT 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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1487057345
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVANT DIABETTES MANAGEMENT LLC
Provider Business Mailing Address
First Line : 2225 SW 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-7026
Country : US
Telephone Number : 800-420-1481
Fax Number : 800-361-4480
Provider Business Practice Location Address
First Line : 2225 SW 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-7026
Country : US
Telephone Number : 800-420-1481
Fax Number : 800-361-4480
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. WILLIAMS J DRAGOO
Credential :
Telephone Number : 800-420-1481
Provider Enumeration Date : 10/06/2014
Last Update Date : 10/06/2014

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Directions to “AVANT DIABETTES MANAGEMENT LLC ” Practice Location

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