Healthcare Provider Details

I. General information

NPI: 1073893830
Provider Name (Legal Business Name): ADVANTAGE MEDICAL CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SIXTH ST SUGAR ESTATE
ST THOMAS VI
00802-2635
US

IV. Provider business mailing address

1601 SIXTH ST SUGAR ESTATE
ST THOMAS VI
00802-2635
US

V. Phone/Fax

Practice location:
  • Phone: 516-509-4795
  • Fax: 340-774-3211
Mailing address:
  • Phone: 516-509-4795
  • Fax: 340-774-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number738
License Number StateVI

VIII. Authorized Official

Name: DR. CLINTON SEWELL
Title or Position: OWNER
Credential: M.D.
Phone: 516-509-4795