=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417944794
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCE MEDICAL SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2005
-----------------------------------------------------
Last Update Date | 01/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3306 BROWN RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63114-4328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-993-0998
-----------------------------------------------------
Fax | 314-228-1943
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3306 BROWN RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63114-4328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-993-0998
-----------------------------------------------------
Fax | 314-228-1943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. CASSANDRA WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-993-0998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 00010584
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------