Provider Demographics
NPI:1417944794
Name:ADVANCE MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANCE MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-993-0998
Mailing Address - Street 1:3306 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-4328
Mailing Address - Country:US
Mailing Address - Phone:314-993-0998
Mailing Address - Fax:314-228-1943
Practice Address - Street 1:3306 BROWN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-4328
Practice Address - Country:US
Practice Address - Phone:314-993-0998
Practice Address - Fax:314-228-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00010584251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO588895706Medicaid
MO267525Medicare ID - Type UnspecifiedMEDICARE PROVIDER