Provider Demographics
NPI:1083943484
Name:ADVANTAGE HEALTH & WELLNESS PLLC
Entity Type:Organization
Organization Name:ADVANTAGE HEALTH & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TREMBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-225-9355
Mailing Address - Street 1:699 BURROUGHS ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3361
Mailing Address - Country:US
Mailing Address - Phone:304-225-9355
Mailing Address - Fax:304-225-9358
Practice Address - Street 1:699 BURROUGHS ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3361
Practice Address - Country:US
Practice Address - Phone:304-225-9355
Practice Address - Fax:304-225-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV769111N00000X
WV2330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6371820001OtherCIGNA GOVERNMENT SERVICES
WV11451727OtherCAQH
WV3810003266Medicaid
WV271821OtherCARELINK
WV7254278OtherAETNA
WV5642046OtherFIRST HEALTH
WVP00337891OtherRAIL ROAD MEDICARE
6371820001OtherCIGNA GOVERNMENT SERVICES
WV3810003266Medicaid