1861674871 NPI number — ADVANCED MEDICAL SOLUTIONS LLC

Table of content: (NPI 1861674871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861674871 NPI number — ADVANCED MEDICAL SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MEDICAL SOLUTIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861674871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 879
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63044-0879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-291-2900
Provider Business Mailing Address Fax Number:
800-508-8491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13400 LAKEFRONT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EARTH CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63045-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-291-2900
Provider Business Practice Location Address Fax Number:
800-508-8491
Provider Enumeration Date:
11/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WARREN
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
314-291-2900

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  2005037494 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1861674871 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1861674871 . This is a "CARE IMPROVEMENT PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: DT1640 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1861674871 . This is a "WELLCARE OF MISSOURI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1861674871 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861674871 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1861674871 . This is a "ESSENCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1861674871 . This is a "COVENTRY HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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