Provider Demographics
NPI:1437501400
Name:ADVANCED CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER AUTHORIZED OFFICIA
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:RITTENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-494-2466
Mailing Address - Street 1:40 W BASELINE RD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1258
Mailing Address - Country:US
Mailing Address - Phone:480-588-5102
Mailing Address - Fax:
Practice Address - Street 1:40 W BASELINE RD
Practice Address - Street 2:SUITE #105
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1258
Practice Address - Country:US
Practice Address - Phone:480-398-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29610208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ194245Medicare PIN
AZZ134254Medicare PIN