Provider Demographics
NPI:1417621095
Name:ADVANCE CARE MEDICAL TENNESSEE, INC.
Entity Type:Organization
Organization Name:ADVANCE CARE MEDICAL TENNESSEE, INC.
Other - Org Name:ADVANCE CARE MEDICAL CLARKSVILLE TN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR ADVISER
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 STE 303
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2548
Mailing Address - Country:US
Mailing Address - Phone:931-343-3347
Mailing Address - Fax:
Practice Address - Street 1:1469 TINY TOWN RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-7202
Practice Address - Country:US
Practice Address - Phone:931-343-3347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care