Provider Demographics
NPI:1457303877
Name:ADVANCED PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:ADVANCED PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BUNTEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:636-931-4206
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:HERCULANEUM
Mailing Address - State:MO
Mailing Address - Zip Code:63048-0217
Mailing Address - Country:US
Mailing Address - Phone:636-931-4206
Mailing Address - Fax:636-931-5774
Practice Address - Street 1:751 SAPPINGTON RIDGE RD
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-2354
Practice Address - Country:US
Practice Address - Phone:636-931-4206
Practice Address - Fax:636-931-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2007-10-18
Deactivation Date:2007-09-28
Deactivation Code:
Reactivation Date:2007-10-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty