Provider Demographics
NPI:1205947363
Name:ADVANCE MEDICAL SERVICES WELLNESS CENTER
Entity type:Organization
Organization Name:ADVANCE MEDICAL SERVICES WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILTON-KYER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:314-993-0998
Mailing Address - Street 1:680 CRAIG RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7120
Mailing Address - Country:US
Mailing Address - Phone:314-993-0998
Mailing Address - Fax:314-567-1940
Practice Address - Street 1:2601 WHITTIER ST
Practice Address - Street 2:SUITE #3
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-2957
Practice Address - Country:US
Practice Address - Phone:314-535-4040
Practice Address - Fax:314-535-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral CareGroup - Multi-Specialty