Provider Demographics
NPI:1497042642
Name:ADVENT MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:ADVENT MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAAID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOJASTEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-939-2550
Mailing Address - Street 1:255 SPENCER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2494
Mailing Address - Country:US
Mailing Address - Phone:636-939-2550
Mailing Address - Fax:636-939-2551
Practice Address - Street 1:255 SPENCER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2494
Practice Address - Country:US
Practice Address - Phone:636-939-2550
Practice Address - Fax:636-939-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty