Healthcare Provider Details

I. General information

NPI: 1922060128
Provider Name (Legal Business Name): ADVANTAGE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 E 23RD ST
LAWRENCE KS
66046-5004
US

IV. Provider business mailing address

1104 E 23RD ST
LAWRENCE KS
66046-5004
US

V. Phone/Fax

Practice location:
  • Phone: 785-749-0130
  • Fax: 785-749-0132
Mailing address:
  • Phone: 785-749-0130
  • Fax: 785-749-0132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberBRA0103693
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number424928
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0428304
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17903
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number430567
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number64063
License Number StateKS

VIII. Authorized Official

Name: DR. DOUGLAS KNOX
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 785-749-0130