1023726171 NPI number — ADVANTAGE MEDICAL SUPPLY, INC.

Table of content: (NPI 1023726171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023726171 NPI number — ADVANTAGE MEDICAL SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANTAGE MEDICAL SUPPLY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023726171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
953 W 700 N STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOGAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84321-7801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-770-7181
Provider Business Mailing Address Fax Number:
888-775-8787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2880 S MAIN ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH SALT LAKE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84115-6001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-290-9527
Provider Business Practice Location Address Fax Number:
888-775-8787
Provider Enumeration Date:
11/08/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MEACHAM
Authorized Official First Name:
SHANE
Authorized Official Middle Name:
EVAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
435-734-0488

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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