Provider Demographics
NPI:1780640151
Name:ADVANCED HEALTHCARE MANAGEMENT SERVICES, LLC
Entity type:Organization
Organization Name:ADVANCED HEALTHCARE MANAGEMENT SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARDA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA CMA
Authorized Official - Phone:573-778-0020
Mailing Address - Street 1:4061 HIGHWAY PP
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3967
Mailing Address - Country:US
Mailing Address - Phone:573-778-0020
Mailing Address - Fax:573-778-1647
Practice Address - Street 1:RR 4 BOX 4269
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:63638-7427
Practice Address - Country:US
Practice Address - Phone:573-663-2511
Practice Address - Fax:573-663-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO179001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261304Medicare ID - Type Unspecified