Provider Demographics
NPI:1578744413
Name:ADVANCED CARE INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:ADVANCED CARE INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIANWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-629-5113
Mailing Address - Street 1:PO BOX 2106
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244-2106
Mailing Address - Country:US
Mailing Address - Phone:480-629-5113
Mailing Address - Fax:480-821-2309
Practice Address - Street 1:485 S DOBSON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5602
Practice Address - Country:US
Practice Address - Phone:480-629-5113
Practice Address - Fax:480-821-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ074612Medicaid
AZH73666Medicare UPIN
AZ109040Medicare PIN
AZ109039Medicare PIN