Provider Demographics
NPI:1821305376
Name:ADVANCED SENIOR CARE, INC
Entity Type:Organization
Organization Name:ADVANCED SENIOR CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUGGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-642-1215
Mailing Address - Street 1:910 N COLLEGE AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4797
Mailing Address - Country:US
Mailing Address - Phone:636-642-1215
Mailing Address - Fax:573-234-4799
Practice Address - Street 1:910 N COLLEGE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4797
Practice Address - Country:US
Practice Address - Phone:636-642-1215
Practice Address - Fax:573-234-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-04
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty