Provider Demographics
NPI:1497400758
Name:ADVANCE CARE MEDICAL PCP TENNESSEE
Entity Type:Organization
Organization Name:ADVANCE CARE MEDICAL PCP TENNESSEE
Other - Org Name:ADVANCE CARE MEDICAL CHATTANOOGA TN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR ADVISOR
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:866-668-2188
Mailing Address - Fax:
Practice Address - Street 1:6238 LEE HWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2997
Practice Address - Country:US
Practice Address - Phone:866-668-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care