Provider Demographics
NPI:1376623207
Name:ADVENTIST PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:ADVENTIST PHYSICIAN SERVICES, INC.
Other - Org Name:ADVENTIST MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:301-315-3171
Mailing Address - Street 1:820 WEST DIAMOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-315-3826
Mailing Address - Fax:301-315-3728
Practice Address - Street 1:820 WEST DIAMOND AVENUE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878
Practice Address - Country:US
Practice Address - Phone:301-315-3826
Practice Address - Fax:301-315-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02382Medicare PIN