Provider Demographics
NPI:1750640413
Name:ADVANCED MULTI SPECIALTY MEDICAL GROUP
Entity Type:Organization
Organization Name:ADVANCED MULTI SPECIALTY MEDICAL GROUP
Other - Org Name:AS SOON AS POSSIBLE MEDICAL CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAMVOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-276-4845
Mailing Address - Street 1:1460 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1821
Mailing Address - Country:US
Mailing Address - Phone:510-276-4845
Mailing Address - Fax:
Practice Address - Street 1:4180 TREAT BLVD STE A1
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518
Practice Address - Country:US
Practice Address - Phone:925-395-8357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27718111N00000X
CAC42153208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty