Provider Demographics
NPI:1124195391
Name:ADVANCED HEALTHCARE MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE MANAGEMENT SERVICES, LLC
Other - Org Name:ADVANCED FAMILY HEALTHCARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NOT APPLICABLE
Authorized Official - Phone:573-778-0020
Mailing Address - Street 1:PO BOX 989
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-0989
Mailing Address - Country:US
Mailing Address - Phone:573-778-0020
Mailing Address - Fax:573-686-2890
Practice Address - Street 1:2002 KANELL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4042
Practice Address - Country:US
Practice Address - Phone:573-778-9292
Practice Address - Fax:573-778-0801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED HEALTHCARE MANAGEMENT SERVICES, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
268573Medicare Oscar/Certification
MO000013896Medicare PIN