Provider Demographics
NPI:1841225091
Name:ADVANCED HEALTHCARE ASSOCIATES LLP
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST MANAGER, PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:KAIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-222-0042
Mailing Address - Street 1:12420 MILESTONE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-7111
Mailing Address - Country:US
Mailing Address - Phone:240-686-2300
Mailing Address - Fax:240-686-2330
Practice Address - Street 1:2300 PARKVIEW LN
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-1378
Practice Address - Country:US
Practice Address - Phone:844-474-4019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207QG0300X, 207R00000X, 207RG0300X, 363L00000X, 363LA2200X, 363LF0000X, 363LG0600X
IN207R00000X, 207RG0300X, 363L00000X, 363LA2200X, 363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100225520Medicaid
KYDR2810OtherRR MEDICARE PIN
IN100460560AMedicaid
KY7100226770Medicaid
INCI1868OtherRR MEDICARE PIN
KYP100038076Medicare PIN
KYDR2810OtherRR MEDICARE PIN