Provider Demographics
NPI:1669814026
Name:ADVANCED WELLNESS SYSTEMS, LLC
Entity Type:Organization
Organization Name:ADVANCED WELLNESS SYSTEMS, LLC
Other - Org Name:PAIN & ARTHRITIS RELIEF CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-361-2225
Mailing Address - Street 1:46 W GUDE DR STE B
Mailing Address - Street 2:SUITE 46B
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4358
Mailing Address - Country:US
Mailing Address - Phone:240-361-2225
Mailing Address - Fax:
Practice Address - Street 1:46 W GUDE DR STE B
Practice Address - Street 2:SUITE 46B
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4358
Practice Address - Country:US
Practice Address - Phone:240-361-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02024111N00000X
MDD30681207X00000X
MDD0066496208VP0000X
MD234952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD225701YE93Medicare UPIN
MD00B345P79Medicare UPIN