Provider Demographics
NPI:1073893830
Name:ADVANTAGE MEDICAL CARE, PC
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-509-4795
Mailing Address - Street 1:1601 SIXTH ST
Mailing Address - Street 2:SUGAR ESTATE
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2635
Mailing Address - Country:US
Mailing Address - Phone:516-509-4795
Mailing Address - Fax:340-774-3211
Practice Address - Street 1:1601 SIXTH ST
Practice Address - Street 2:SUGAR ESTATE
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2635
Practice Address - Country:US
Practice Address - Phone:516-509-4795
Practice Address - Fax:340-774-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI738261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care