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General NPI Number Information
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NPI Number | 1295991008
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Entity Type | Organization
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Legal Business Name | ADVANCED MEDICAL CENTERS, LLC
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 1105 W 163RD AVE
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City | CROWN POINT
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State | IN
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Zip | 46307-9233
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Country | US
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Telephone | 219-756-6605
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Fax | 219-756-6615
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Provider Business Mailing Address
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Address Line | 155 W 86TH AVE UNIT B
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7089
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Country | US
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Telephone | 219-756-6605
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Fax | 219-756-6615
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. VICKI R MUTHART
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Credential | CMA
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Telephone | 219-756-6605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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