Healthcare Provider Details

I. General information

NPI: 1356442669
Provider Name (Legal Business Name): ADVANCED HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 NE DOUGLAS ST
LEES SUMMIT MO
64086-4701
US

IV. Provider business mailing address

1631 NE DOUGLAS ST
LEES SUMMIT MO
64086-4701
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-6688
  • Fax: 816-554-7227
Mailing address:
  • Phone: 816-525-6688
  • Fax: 816-554-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: DR. RAYMOND VASQUEZ
Title or Position: PRESIDENT
Credential:
Phone: 816-525-6688