Provider Demographics
NPI:1124084702
Name:ADVANCED HEALTHCARE
Entity type:Organization
Organization Name:ADVANCED HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAMILY PRACTICE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMETT
Authorized Official - Middle Name:FULCHER
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-664-4000
Mailing Address - Street 1:191A W PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6806
Mailing Address - Country:US
Mailing Address - Phone:704-664-4000
Mailing Address - Fax:704-660-5251
Practice Address - Street 1:191A W PLAZA DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6806
Practice Address - Country:US
Practice Address - Phone:704-664-4000
Practice Address - Fax:704-660-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2327040Medicare ID - Type Unspecified