Healthcare Provider Details

I. General information

NPI: 1104634377
Provider Name (Legal Business Name): MEDADVANCE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S GAY ST STE 700
KNOXVILLE TN
37929-9703
US

IV. Provider business mailing address

731 BAY AVE
SOMERS POINT NJ
08244-2378
US

V. Phone/Fax

Practice location:
  • Phone: 440-652-8748
  • Fax: 440-582-3171
Mailing address:
  • Phone:
  • Fax: 440-582-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRACY WIMBERG
Title or Position: VP BILLING OPERATIONS
Credential:
Phone: 609-517-2526