ADVANCED MEDICAL GROUP (NPI# 1932741907) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932741907 |
| Entity Type | Organization |
| Organization Name | ADVANCED MEDICAL GROUP |
| Practice Address |
3360 Prospect St Hudsonville MI 49426-1420 |
| Practice Telephone | 6166696702 |
| Practice Fax Number | 6167974025 |
| Mailing Telephone | 6166696702 |
| Mailing Fax Number | 6167974025 |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2020-02-03 |
| Authorized Official Name | DR. BENJAMIN EOVALDI (PROVIDER) |
| Authorized Official Telephone | 6166696702 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CAQH# | 14554401 | 01 | |
| NPI TYPE 1 | 1902155690 | 01 | |
| MI CONTROLLED SUBSTANCE | 5315213606 | 01 | |
| MI OSTEOPATHIC MEDICAL LICENSE | 5101019505 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184232670 | Advanced Medical Group | Dermatology | 135 W Dimond Blvd Ste 104, Anchorage, AK 99515-1907 | 2020-07-21 |
| 1205167509 | Advanced Medical Group | Nurse Practitioner | 717 Watkins Rd, Maryville, TN 37801-4598 | 2010-01-26 |
| 1992723639 | Advanced Medical Group | Rehabilitation Practitioner | 155 Union St, Springfield, MA 01105-2010 | 2006-07-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Advanced Medical Group Pikes Peak, LLC | 2728 Golden Current View, Colorado Springs, CO 80918 |
| New York State Corporations | ADVANCED MEDICAL GROUP, P.C. | 2044 Ocean Avenue / Suite A-3, Brooklyn, Ny 11230 |
| Street Address |
3360 PROSPECT ST |
| City | HUDSONVILLE |
| State | MI |
| Zip Code | 49426-1420 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477567824 | Daniel Lee Osborn | Chiropractor | 3360 Prospect St, Hudsonville, MI 49426-1420 | 2006-07-28 |
| 1508266040 | Hudsonville Chiropractic, Pllc | Chiropractor | 3360 Prospect St, Hudsonville, MI 49426-1420 | 2014-09-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528680089 | Bree D Bode | Health Educator | 3625 Black Star St, Hudsonville, MI 49426 | 2020-05-07 |
| 1306409891 | Rachael Elizabeth Schutter | Physical Therapy Assistant | 3650 Vanburen St, Hudsonville, MI 49426 | 2019-04-19 |
| 1215430699 | Jennifer Anne-gluszewski Patterson | Physical Therapist | 6105 Wilson Ave, Wyoming, MI 49426 | 2018-03-13 |
| 1457850802 | Spectrum Health Primary Care Partners | Physician Assistant | 4075 32nd Ave, Hudsonville, MI 49426 | 2018-02-12 |
| 1952845182 | Katie Farnquist | Counselor | 1388 Baldwin St., Suite A, Jenison, MI 49426 | 2016-12-07 |
| 1205238540 | Marta Stern | Mechanotherapist | 3152a Port Sheldon Rd., Hudsonville, MI 49426 | 2014-09-18 |
| 1376883355 | Traci L Potter | Social Worker | 4216 Nancy St., Hudsonville, MI 49426 | 2013-02-27 |
| 1871846790 | Dignity Home Care Professionals | Home Health | 7499 Russell Dr, Hudsonville, MI 49426 | 2012-10-16 |
| 1427332303 | Benjamin Matthew Bringedahl | Pharmacist | 3457 Stonyridge Dr, Hudsonville, MI 49426 | 2011-10-10 |
| 1295017234 | Jennifer Lemieux | Pharmacist | 1463 Rebecca Run, Hudsonville, MI 49426 | 2011-09-15 |
| Find all providers in zip 49426 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528294493 | Willard E Walton | General Practice | 4957 Tyler Oaks Dr, Hudsonville, MI 49426-9796 | 2009-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326649120 | Source Medical Solutions Pllc | General Practice | 625 Kenmoor Ave Se Ste 301, Grand Rapids, MI 49546-2395 | 2020-11-06 |
| 1043832801 | Ksk Medical Pllc | General Practice | 6300 Winter Rd, Manitou Beach, MI 49253-9634 | 2020-05-14 |
| 1275184921 | Home Physicians Group Inc | General Practice | 18481 W 10 Mile Rd Ste 102, Southfield, MI 48075-2621 | 2019-09-24 |
| 1558913251 | Baybrooke Counseling | General Practice | 421 St. Josephs Ave, Suttons Bay, MI 49682 | 2019-07-12 |
| 1962062539 | Healthcare Alliance Pllc | General Practice | 35 S Johnson St Ste 1b, Pontiac, MI 48341-1660 | 2019-06-17 |
| 1356905061 | Comprehensive Care Medical Services | General Practice | 1747 Andover Ln Se, East Grand Rapids, MI 49506-4805 | 2019-04-29 |
| 1336602812 | Mk Certified, LLC | General Practice | 2140 Stone Rd, Ann Arbor, MI 48105-2535 | 2019-04-10 |
| 1215422555 | The Natural Momma Me Initiative | General Practice | 11000 W Mcnichols Rd Ste 212, Detroit, MI 48221-2389 | 2018-06-28 |
| 1881183028 | Silverstone Medical Group, Pllc | General Practice | 805 Oakwood Dr Ste 111, Rochester, MI 48307-1359 | 2018-05-03 |
| 1245739903 | Breanna Lee Brookens | General Practice | 1531 Barnard St, Saginaw, MI 48602-4902 | 2018-02-08 |
| Find all providers with the same taxonomy | ||||
| City | HUDSONVILLE |
| Zip Code | 49426 |
Please comment or provide details below to improve the information on ADVANCED MEDICAL GROUP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.