Provider Demographics
NPI:1265691869
Name:ADVANCE MEDICAL CLINIC
Entity type:Organization
Organization Name:ADVANCE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:573-722-3467
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:103 SOUTH OAK STREET
Mailing Address - City:ADVANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63730-0669
Mailing Address - Country:US
Mailing Address - Phone:573-722-3467
Mailing Address - Fax:573-722-3469
Practice Address - Street 1:103 SOUTH OAK STREET
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:MO
Practice Address - Zip Code:63730
Practice Address - Country:US
Practice Address - Phone:573-722-3467
Practice Address - Fax:573-722-3469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center