Healthcare Provider Details

I. General information

NPI: 1225458953
Provider Name (Legal Business Name): ADVANTICA ADMINISTRATIVE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12399 GRAVOIS RD 2ND FLOOR
SAINT LOUIS MO
63127-1750
US

IV. Provider business mailing address

12399 GRAVOIS RD 2ND FLOOR
SAINT LOUIS MO
63127-1750
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-4900
  • Fax:
Mailing address:
  • Phone: 314-543-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBARA C. BENTRUP
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 314-656-2720