Provider Demographics
NPI:1992762942
Name:ADVANCED HEALTH & REHAB LLC
Entity type:Organization
Organization Name:ADVANCED HEALTH & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-782-2504
Mailing Address - Street 1:3120 S MAIN ST
Mailing Address - Street 2:STE 5
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2608
Mailing Address - Country:US
Mailing Address - Phone:417-782-2504
Mailing Address - Fax:417-553-7760
Practice Address - Street 1:3120 S MAIN ST
Practice Address - Street 2:STE 5
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2608
Practice Address - Country:US
Practice Address - Phone:417-782-2504
Practice Address - Fax:417-553-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20044021789261QM1300X
MO006161261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014376Medicare ID - Type UnspecifiedCHIROPRACTIC
MO266640Medicare ID - Type UnspecifiedOUT PATIENT REHAB FACILIT