MEDICARE: ADVANCED SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency		ID

General Provider Information

NPI Number	:	1336488261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SERVICES

Provider Business Mailing Address
First Line	:	210 HOLLY ST
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5104
Country	:	US
Telephone Number	:	208-461-0438
Fax Number	:	208-461-0446

Provider Business Practice Location Address
First Line	:	210 HOLLY ST
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5104
Country	:	US
Telephone Number	:	208-461-0438
Fax Number	:	208-461-0446

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LOUISE PYROR
Credential	:
Telephone Number	:	208-461-0438

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	02/13/2013

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Directions to “ADVANCED SERVICES ” Practice Location

Language	Start Address	Practice Location

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