Provider Demographics
NPI:1033956057
Name:ULTRA HEALTH PROVIDERS II LLC
Entity type:Organization
Organization Name:ULTRA HEALTH PROVIDERS II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:JERMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:731-234-8120
Mailing Address - Street 1:PO BOX 26485
Mailing Address - Street 2:DEPT 1138
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126
Mailing Address - Country:US
Mailing Address - Phone:731-394-1145
Mailing Address - Fax:
Practice Address - Street 1:4128 OLD JACKSON RD
Practice Address - Street 2:
Practice Address - City:BELLS
Practice Address - State:TN
Practice Address - Zip Code:38006-4261
Practice Address - Country:US
Practice Address - Phone:731-394-1145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty