Provider Demographics
NPI:1013638832
Name:MED-ADVO-C LLC
Entity Type:Organization
Organization Name:MED-ADVO-C LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURRAY-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-972-9715
Mailing Address - Street 1:1505 YORKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8088
Mailing Address - Country:US
Mailing Address - Phone:708-972-0915
Mailing Address - Fax:630-326-3382
Practice Address - Street 1:1505 YORKSHIRE CT
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8088
Practice Address - Country:US
Practice Address - Phone:708-972-9715
Practice Address - Fax:630-326-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care