Provider Demographics
NPI:1245228154
Name:ADVANCED MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-264-6644
Mailing Address - Street 1:1700 BRANHAM LN
Mailing Address - Street 2:A10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-2256
Mailing Address - Country:US
Mailing Address - Phone:408-264-6644
Mailing Address - Fax:408-264-3515
Practice Address - Street 1:1700 BRANHAM LN
Practice Address - Street 2:A10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-2256
Practice Address - Country:US
Practice Address - Phone:408-264-6644
Practice Address - Fax:408-264-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU42098Medicare UPIN
CAF82012Medicare UPIN
CAZZZ29214ZMedicare ID - Type Unspecified