Healthcare Provider Details

I. General information

NPI: 1891397881
Provider Name (Legal Business Name): ADVANCED CLIENT SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 EXECUTIVE CENTRE PARKWAY LOOP N
SAINT PETERS MO
63376-6417
US

IV. Provider business mailing address

4208 EXECUTIVE CENTRE PARKWAY LOOP N
SAINT PETERS MO
63376-6417
US

V. Phone/Fax

Practice location:
  • Phone: 573-301-0902
  • Fax: 888-535-8328
Mailing address:
  • Phone: 573-301-0902
  • Fax: 888-535-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. D MARHANKA
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 573-301-0902