Provider Demographics
NPI:1003845884
Name:ADVANCED MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:KACHEROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-520-2500
Mailing Address - Street 1:81 S MILWAUKEE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3120
Mailing Address - Country:US
Mailing Address - Phone:847-520-2500
Mailing Address - Fax:847-520-2505
Practice Address - Street 1:81 S MILWAUKEE AVE
Practice Address - Street 2:STE A
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3120
Practice Address - Country:US
Practice Address - Phone:847-520-2500
Practice Address - Fax:847-520-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000531332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL4298080002Medicare NSC