Healthcare Provider Details

I. General information

NPI: 1619225869
Provider Name (Legal Business Name): ADVANCED HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S IDAHO RD SUITE 140
APACHE JUNCTION AZ
85119-2379
US

IV. Provider business mailing address

110 S IDAHO RD SUITE 140
APACHE JUNCTION AZ
85119-2379
US

V. Phone/Fax

Practice location:
  • Phone: 480-671-5655
  • Fax: 480-671-5705
Mailing address:
  • Phone: 480-671-5655
  • Fax: 480-671-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberRN047495
License Number StateAZ

VIII. Authorized Official

Name: PHILLIP POKORNY
Title or Position: OWNER
Credential: D.C.
Phone: 480-671-5655