Provider Demographics
NPI:1114427507
Name:ADVANCE CARE, LLC
Entity Type:Organization
Organization Name:ADVANCE CARE, LLC
Other - Org Name:CAREONE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-397-4079
Mailing Address - Street 1:14 NORTHTOWN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3018
Mailing Address - Country:US
Mailing Address - Phone:601-397-4079
Mailing Address - Fax:
Practice Address - Street 1:14 NORTHTOWN DR STE 105
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3018
Practice Address - Country:US
Practice Address - Phone:601-397-4079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00855040Medicaid