Provider Demographics
NPI:1083918338
Name:ADVANCED HEALTH AND PHYSICAL MEDICINE PLLC
Entity Type:Organization
Organization Name:ADVANCED HEALTH AND PHYSICAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:KEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-321-3579
Mailing Address - Street 1:PO BOX 4843
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4843
Mailing Address - Country:US
Mailing Address - Phone:252-321-3579
Mailing Address - Fax:
Practice Address - Street 1:504-C RED BANKS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5766
Practice Address - Country:US
Practice Address - Phone:252-321-3579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6495070001Medicare NSC