Provider Demographics
NPI:1487057345
Name:AVANT DIABETTES MANAGEMENT LLC
Entity type:Organization
Organization Name:AVANT DIABETTES MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRAGOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-420-1481
Mailing Address - Street 1:2225 SW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-7026
Mailing Address - Country:US
Mailing Address - Phone:800-420-1481
Mailing Address - Fax:800-361-4480
Practice Address - Street 1:2225 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7026
Practice Address - Country:US
Practice Address - Phone:800-420-1481
Practice Address - Fax:800-361-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center