Healthcare Provider Details

I. General information

NPI: 1417944794
Provider Name (Legal Business Name): ADVANCE MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/28/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 BROWN RD
SAINT LOUIS MO
63114-4328
US

IV. Provider business mailing address

3306 BROWN RD
SAINT LOUIS MO
63114-4328
US

V. Phone/Fax

Practice location:
  • Phone: 314-993-0998
  • Fax: 314-228-1943
Mailing address:
  • Phone: 314-993-0998
  • Fax: 314-228-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number00010584
License Number StateMO

VIII. Authorized Official

Name: MS. CASSANDRA WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 314-993-0998