MEDICARE: ADVANCED CLIENT SOLUTIONS, LLC

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	291U00000X	Clinical Medical Laboratory
2	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1891397881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CLIENT SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	4208 EXECUTIVE CENTRE PARKWAY LOOP N
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-6417
Country	:	US
Telephone Number	:	573-301-0902
Fax Number	:	888-535-8328

Provider Business Practice Location Address
First Line	:	4208 EXECUTIVE CENTRE PARKWAY LOOP N
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-6417
Country	:	US
Telephone Number	:	573-301-0902
Fax Number	:	888-535-8328

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. D MARHANKA
Credential	:
Telephone Number	:	573-301-0902

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	10/08/2021

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