Provider Demographics
NPI:1164704649
Name:ADVANCE MEDICAL OF NAPLES LLC
Entity Type:Organization
Organization Name:ADVANCE MEDICAL OF NAPLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:239-254-3104
Mailing Address - Street 1:720 GOODLETTE RD N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5656
Mailing Address - Country:US
Mailing Address - Phone:239-566-7676
Mailing Address - Fax:239-254-3105
Practice Address - Street 1:720 GOODLETTE RD N
Practice Address - Street 2:SUITE 300
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5656
Practice Address - Country:US
Practice Address - Phone:239-566-7676
Practice Address - Fax:239-254-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGZ503AMedicare UPIN