1710194691 NPI number — ADVANCED MEDICAL CENTERS LLC

Table of content: (NPI 1710194691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710194691 NPI number — ADVANCED MEDICAL CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MEDICAL CENTERS 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:
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:
1710194691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7900 103RD ST
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32210-6681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-908-5780
Provider Business Mailing Address Fax Number:
904-908-5781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 103RD ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32210-6681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-908-5780
Provider Business Practice Location Address Fax Number:
904-908-5781
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
F. CARTER
Authorized Official Middle Name:
Authorized Official Title or Position:
MGRM
Authorized Official Telephone Number:
904-908-5780

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com