Provider Demographics
NPI:1104634377
Name:MEDADVANCE PLLC
Entity type:Organization
Organization Name:MEDADVANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BILLING OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-517-2526
Mailing Address - Street 1:731 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2378
Mailing Address - Country:US
Mailing Address - Phone:609-517-2526
Mailing Address - Fax:267-907-8012
Practice Address - Street 1:731 BAY AVE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2378
Practice Address - Country:US
Practice Address - Phone:865-888-9958
Practice Address - Fax:440-582-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty