Provider Demographics
NPI:1326223074
Name:ADVOCARE, LLC
Entity Type:Organization
Organization Name:ADVOCARE, LLC
Other - Org Name:ADVANCED PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PAYER RELATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGGONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-334-6025
Mailing Address - Street 1:PO BOX 71422
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19176-1422
Mailing Address - Country:US
Mailing Address - Phone:856-872-7055
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:111 VINE ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1447
Practice Address - Country:US
Practice Address - Phone:609-561-2518
Practice Address - Fax:609-567-0934
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-31
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
31D0118078OtherCLIA
31D0118078OtherCLIA