Provider Demographics
NPI:1144348509
Name:ADVANCED CARE CENTER, LLC
Entity type:Organization
Organization Name:ADVANCED CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:EBERTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-265-9900
Mailing Address - Street 1:703 GREEN RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2145
Mailing Address - Country:US
Mailing Address - Phone:812-265-9900
Mailing Address - Fax:812-265-9998
Practice Address - Street 1:2001 CHARLOTTE AVE
Practice Address - Street 2:SUITE205
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2032
Practice Address - Country:US
Practice Address - Phone:812-265-9900
Practice Address - Fax:812-265-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060297174400000X
IN01044433174400000X
TN34216174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherTID