Advance Care, LLC
Organization Active NPI Family Medicine Physician · Jackson, MS
NPI 1114427507 · NPPES record last updated Jun 16, 2018
Key facts
- NPI
- 1114427507
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ADVANCE CARE, LLC
- Practice address
- 14 Northtown Dr Ste 105
Jackson, MS 39211-3018 - Phone
- (601) 397-4079
- NPI assigned
- Feb 13, 2018
- Organization subpart
- No
Authorized official
- Name
- Tye Rollins
- Title
- Cfo, Clinical Director
- Phone
- (601) 397-4079
National Provider Directory
Locations
14 Northtown Dr
Ste 105
Jackson, MS 39211
Phone (601) 397-4079
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Primary Care Clinic/Center | 261QP2300X | |||
| Urgent Care Clinic/Center | 261QU0200X |
Addresses
Primary practice location
14 Northtown Dr Ste 105
Jackson, MS 39211-3018
Mailing address
14 Northtown Dr Ste 105
Jackson, MS 39211-3018
Phone (601) 397-4079
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00855040 | Medicaid | MS |
Other names
- CareOne Medical Clinic
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All providers in Jackson, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.