MEDICARE: ADVANCE THERAPUTIC SERVICES INC

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275293318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE THERAPUTIC SERVICES INC

Provider Business Mailing Address
First Line	:	5456 NW 122ND DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3638
Country	:	US
Telephone Number	:	954-270-5626
Fax Number	:

Provider Business Practice Location Address
First Line	:	7431 SW 8TH CT
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-2378
Country	:	US
Telephone Number	:	954-270-5626
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JULIA M MCDONALD
Credential	:	MASTERS
Telephone Number	:	954-270-5626

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	12/29/2021

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Directions to “ADVANCE THERAPUTIC SERVICES INC ” Practice Location

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