Provider Demographics
NPI:1225458953
Name:ADVANTICA ADMINISTRATIVE SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANTICA ADMINISTRATIVE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-656-2720
Mailing Address - Street 1:12399 GRAVOIS RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1750
Mailing Address - Country:US
Mailing Address - Phone:314-543-4900
Mailing Address - Fax:
Practice Address - Street 1:12399 GRAVOIS RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1750
Practice Address - Country:US
Practice Address - Phone:314-543-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization