Provider Demographics
NPI:1598281057
Name:ADVANCED MEDICAL & WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL & WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-427-2225
Mailing Address - Street 1:3060 DAYTON XENIA RD STE C
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6393
Mailing Address - Country:US
Mailing Address - Phone:937-427-2225
Mailing Address - Fax:937-405-1078
Practice Address - Street 1:3060 DAYTON XENIA RD STE A
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6393
Practice Address - Country:US
Practice Address - Phone:937-427-2225
Practice Address - Fax:937-405-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty