ADVANCED MEDICAL GROUP NPI 1932741907

NPI Information

NPI: 1932741907
Provider Name: ADVANCED MEDICAL GROUP
Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
3360 PROSPECT ST
HUDSONVILLE, MI
ZIP 49426
Phone: (616) 669-6702
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ADVANCED MEDICAL GROUP is a general practice in Hudsonville, MI. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee ADVANCED MEDICAL GROUP NPI is 1932741907. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3360 PROSPECT ST
HUDSONVILLE, MI
ZIP 49426-420
Phone: (616) 669-6702
Fax: (616) 797-4025

The provider's authorized official is Benjamin Eovaldi .
The authorized official title is Provider and has the following contact phone number (616) 669-6702.

The enumeration date for this NPI number is 10/11/2019 and was last updated on 2/3/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier Issuer
1	14554401	OTHER	CAQH#
2	1902155690	OTHER	NPI TYPE 1
3	5315213606	OTHER	MI CONTROLLED SUBSTANCE
4	5101019505	OTHER	MI OSTEOPATHIC MEDICAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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