Provider Demographics
NPI:1154372464
Name:ADVANCED PSYCHIATRIC SERVICES INC
Entity type:Organization
Organization Name:ADVANCED PSYCHIATRIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BUN TEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:636-931-4206
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:HERCULANEUM
Mailing Address - State:MO
Mailing Address - Zip Code:63048-0217
Mailing Address - Country:US
Mailing Address - Phone:636-931-4206
Mailing Address - Fax:636-931-5774
Practice Address - Street 1:807 COLLINS DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2346
Practice Address - Country:US
Practice Address - Phone:636-931-4206
Practice Address - Fax:636-931-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO502857709Medicaid
MO000013010Medicare PIN