Provider Demographics
NPI:1407487119
Name:ADVANCED LIFESTYLE CARE PC
Entity Type:Organization
Organization Name:ADVANCED LIFESTYLE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-613-8130
Mailing Address - Street 1:6195 MARCELLA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-0040
Mailing Address - Country:US
Mailing Address - Phone:219-942-7100
Mailing Address - Fax:219-945-0045
Practice Address - Street 1:6195 MARCELLA BLVD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-0040
Practice Address - Country:US
Practice Address - Phone:219-942-7100
Practice Address - Fax:219-945-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain