1285860460 NPI number — ADVANCED HOME MEDICAL SUPPLY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285860460 NPI number — ADVANCED HOME MEDICAL SUPPLY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED HOME MEDICAL SUPPLY LLC
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:
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:
1285860460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
742 MINK AVE
Provider Second Line Business Mailing Address:
PMB 742
Provider Business Mailing Address City Name:
MURRELLS INLET
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29576-6300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-900-8388
Provider Business Mailing Address Fax Number:
877-900-8388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
742 MINK AVE
Provider Second Line Business Practice Location Address:
PMB 742
Provider Business Practice Location Address City Name:
MURRELLS INLET
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29576-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-900-8388
Provider Business Practice Location Address Fax Number:
877-900-8388
Provider Enumeration Date:
06/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HERLOCKER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
AUSTIN
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
877-900-8388

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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