Provider Demographics
NPI:1619225869
Name:ADVANCED HEALTHCARE LLC
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:POKORNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-671-5655
Mailing Address - Street 1:110 S IDAHO RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-2379
Mailing Address - Country:US
Mailing Address - Phone:480-671-5655
Mailing Address - Fax:480-671-5705
Practice Address - Street 1:110 S IDAHO RD
Practice Address - Street 2:SUITE 140
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85119-2379
Practice Address - Country:US
Practice Address - Phone:480-671-5655
Practice Address - Fax:480-671-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN047495208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU61779Medicare UPIN