Provider Demographics
NPI:1942949458
Name:ADVANCE MEDICAL ACADEMY LLC
Entity Type:Organization
Organization Name:ADVANCE MEDICAL ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKENER-STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:803-729-6503
Mailing Address - Street 1:912 MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4125
Mailing Address - Country:US
Mailing Address - Phone:803-729-6503
Mailing Address - Fax:
Practice Address - Street 1:912 MITCHELL DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4125
Practice Address - Country:US
Practice Address - Phone:803-729-6503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare