Provider Demographics
NPI:1083088058
Name:ADVANCED MEDICAL HOUSE CALL AND TELEMEDICINE, L.L.C.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL HOUSE CALL AND TELEMEDICINE, L.L.C.
Other - Org Name:ADVANCED MEDICAL EXPRESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:660-268-4006
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-0224
Mailing Address - Country:US
Mailing Address - Phone:660-530-9992
Mailing Address - Fax:660-530-9992
Practice Address - Street 1:624 W LOCKLING ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-2003
Practice Address - Country:US
Practice Address - Phone:660-268-4006
Practice Address - Fax:660-258-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014033136261QP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083088058OtherGROUP NPI ADVANCED MEDICAL HOUSE CALL AND TELEMEDICINE, LLC
1962492223OtherINDIVIDUAL NPI COLLAB. PHYS. TERRY THRASHER DO
1083088058OtherGROUP NPI DBA ADVANCED MEDICAL EXPRESS CLINIC
1518369024OtherINDIVIDUAL NPI MICHAEL HOLTZ FNP-C