MDM Advanced Ancillary Services, LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

MDM ADVANCED ANCILLARY SERVICES, LLC

Doing business as

Advanced Ancillary Services

Practice address

19065 Hickory Creek PL
Suite 240
Mokena, IL 60448-8507

Phone

(708) 478-6417

Fax

(708) 535-8087

NPI assigned

Mar 26, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jon Knipper

Title

Chief Operating Officer

Phone

(708) 478-6434

Specialties & licenses 1

Addresses

Other names 1

• Advanced Ancillary Services Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336267855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 10116",
            "address_2": "PO BOX 87618",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606800618",
            "telephone_number": "708-478-6417",
            "fax_number": "708-535-8087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19065 HICKORY CREEK PL",
            "address_2": "SUITE 240",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488507",
            "telephone_number": "708-478-6417",
            "fax_number": "708-535-8087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDM ADVANCED ANCILLARY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KNIPPER",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "708-478-6434",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Ancillary Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Exclusive Provider Organization in Mokena, IL
• Providers in Mokena, IL by specialty
• Exclusive Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.