1780636928 NPI number — ADVANCED MEDICAL SOLUTIONS, LLC

Table of content: (NPI 1780636928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780636928 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:
1780636928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14201 LAUREL PARK DR
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20707-5203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-960-4645
Provider Business Mailing Address Fax Number:
301-317-5065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 PROFESSIONAL PL
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
HYATTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20785-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-918-0072
Provider Business Practice Location Address Fax Number:
301-918-1778
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAETJENS
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
EDMOND
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-960-4645

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  M232 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0200X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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