Organization Name: | ADVANCED HEALTHCARE LLC |
NPI Number: | 1619225869 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PHILLIP POKORNY (OWNER) |
Mailing Address: | 110 S Idaho Rd Suite 140 Apache Junction |
State: | AZ US |
Postal Code: | 851192379 |
Phone Number: | 4806715655 |
Fax Number: | 4806715705 |
NPI Enumeration Date: | 08/20/2012 |
NPI Last Update Date: | 11/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | RN047495 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |