Provider Demographics
NPI:1720598360
Name:ADVANTAGE MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-999-2574
Mailing Address - Street 1:1450 E BOOT RD STE 200C
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5999
Mailing Address - Country:US
Mailing Address - Phone:610-343-1333
Mailing Address - Fax:877-233-5612
Practice Address - Street 1:1450 E BOOT RD STE 200C
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5999
Practice Address - Country:US
Practice Address - Phone:610-343-1333
Practice Address - Fax:877-233-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026069200005Medicaid