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General NPI Number Information
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NPI Number | 1619225869
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Entity Type | Organization
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Legal Business Name | ADVANCED HEALTHCARE LLC
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | 110 S IDAHO RD SUITE 140
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City | APACHE JUNCTION
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State | AZ
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Zip | 85119-2379
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Country | US
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Telephone | 480-671-5655
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Fax | 480-671-5705
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Provider Business Mailing Address
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Address Line | 110 S IDAHO RD SUITE 140
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City | APACHE JUNCTION
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State | AZ
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Zip | 85119-2379
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Country | US
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Telephone | 480-671-5655
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Fax | 480-671-5705
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Authorized Official
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Title or Position | OWNER
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Name | PHILLIP POKORNY
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Credential | D.C.
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Telephone | 480-671-5655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | RN047495
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License Number State | AZ
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