Provider Demographics
NPI:1508063405
Name:ADVANCED INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:ADVANCED INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:CHASSELS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:618-241-4016
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-0442
Mailing Address - Country:US
Mailing Address - Phone:618-241-4016
Mailing Address - Fax:618-241-3837
Practice Address - Street 1:605 N 12TH ST
Practice Address - Street 2:HOSPITALIST OFFICE
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2857
Practice Address - Country:US
Practice Address - Phone:618-241-4016
Practice Address - Fax:618-241-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty