MEDICARE: ADVANCED MULTI SPECIALTY MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1073712162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MULTI SPECIALTY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1460 150TH AVE
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-1821
Country	:	US
Telephone Number	:	510-276-4845
Fax Number	:	510-276-8452

Provider Business Practice Location Address
First Line	:	37471 FREMONT BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94536-3704
Country	:	US
Telephone Number	:	510-742-5900
Fax Number	:	510-742-5910

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. THOMAS VAMVOURIS
Credential	:	DC
Telephone Number	:	510-276-4845

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	06/25/2008

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