Provider Demographics
NPI:1619517497
Name:ADVANCED MEDICAL SOLUTIONS BY REJUVV
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SOLUTIONS BY REJUVV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-222-2593
Mailing Address - Street 1:3 BLACK HEATH CT # 2
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-6301
Mailing Address - Country:US
Mailing Address - Phone:620-222-2593
Mailing Address - Fax:
Practice Address - Street 1:3 BLACK HEATH CT # 2
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-6301
Practice Address - Country:US
Practice Address - Phone:620-222-2593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty