Provider Demographics
NPI:1275083172
Name:ADVANCED MEDICAL HEALTH CENTER, INC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL HEALTH CENTER, INC
Other - Org Name:ADVANCED MEDICAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-294-8221
Mailing Address - Street 1:10920 BAYMEADOWS RD
Mailing Address - Street 2:SUITE #27
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4570
Mailing Address - Country:US
Mailing Address - Phone:904-683-6880
Mailing Address - Fax:850-558-0224
Practice Address - Street 1:10920 BAYMEADOWS RD
Practice Address - Street 2:SUITE #27
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4570
Practice Address - Country:US
Practice Address - Phone:904-683-6880
Practice Address - Fax:850-558-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHC10563174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0794AMedicare PIN