Provider Demographics
NPI:1811535313
Name:ADVANCE PRACTICE MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:ADVANCE PRACTICE MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:E
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:623-295-2323
Mailing Address - Street 1:13210 W VAN BUREN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1164
Mailing Address - Country:US
Mailing Address - Phone:623-295-2323
Mailing Address - Fax:
Practice Address - Street 1:13210 W VAN BUREN ST STE 100
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1164
Practice Address - Country:US
Practice Address - Phone:623-295-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-15
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty