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General NPI Number Information
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NPI Number | 1114427507
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Entity Type | Organization
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Legal Business Name | ADVANCE CARE, LLC
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 14 NORTHTOWN DR STE 105
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City | JACKSON
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State | MS
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Zip | 39211-3018
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Country | US
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Telephone | 601-397-4079
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Fax |
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Provider Business Mailing Address
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Address Line | 14 NORTHTOWN DR STE 105
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City | JACKSON
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State | MS
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Zip | 39211-3018
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Country | US
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Telephone | 601-397-4079
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Fax |
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Authorized Official
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Title or Position | CFO, CLINICAL DIRECTOR
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Name | TYE ROLLINS
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Credential |
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Telephone | 601-397-4079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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