Provider Demographics
NPI:1396419040
Name:ADVANCE CARE MEDICAL ILLINOIS
Entity Type:Organization
Organization Name:ADVANCE CARE MEDICAL ILLINOIS
Other - Org Name:ADVANCE CARE MEDICAL ROMEOVILLE IL
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR ADVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-673-6321
Mailing Address - Street 1:3 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2590
Mailing Address - Country:US
Mailing Address - Phone:516-801-1552
Mailing Address - Fax:
Practice Address - Street 1:780 S WEBER RD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-7500
Practice Address - Country:US
Practice Address - Phone:516-801-1552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care