Provider Demographics
NPI:1801926290
Name:ADVANCED MEDICAL & WELLNESS LLC
Entity type:Organization
Organization Name:ADVANCED MEDICAL & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-342-5555
Mailing Address - Street 1:430 WILLIAM HILTON PKWY
Mailing Address - Street 2:STE. 508 B
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2424
Mailing Address - Country:US
Mailing Address - Phone:843-342-5555
Mailing Address - Fax:843-342-2255
Practice Address - Street 1:430 WILLIAM HILTON PKWY
Practice Address - Street 2:STE. 508 B
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2424
Practice Address - Country:US
Practice Address - Phone:843-342-5555
Practice Address - Fax:843-342-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2805111N00000X
SC5093208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========001OtherBCBS PROVIDER
SCE91613Medicare UPIN
SC8275Medicare ID - Type Unspecified
SC7658Medicare ID - Type UnspecifiedDR. SHAPIRO
U84921Medicare UPIN