Provider Demographics
NPI:1134354566
Name:ADVANCED PICC SPECIALISTS, INC
Entity type:Organization
Organization Name:ADVANCED PICC SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHRISTODOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-453-6115
Mailing Address - Street 1:7011 MOUNT VISTA RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1331
Mailing Address - Country:US
Mailing Address - Phone:443-226-1676
Mailing Address - Fax:
Practice Address - Street 1:7011 MOUNT VISTA RD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21087-1331
Practice Address - Country:US
Practice Address - Phone:443-226-1676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185270363LA2100X
251E00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty