Provider Demographics
NPI:1023034790
Name:ADVANCED VEHICLE MODIFICATIONS, INC.
Entity Type:Organization
Organization Name:ADVANCED VEHICLE MODIFICATIONS, INC.
Other - Org Name:AVM INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCGUCKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-622-4467
Mailing Address - Street 1:2520 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-5779
Mailing Address - Country:US
Mailing Address - Phone:352-622-4467
Mailing Address - Fax:352-622-4469
Practice Address - Street 1:2520 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-5779
Practice Address - Country:US
Practice Address - Phone:352-622-4467
Practice Address - Fax:352-622-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1466332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9191OtherBLUE CROSS BLUE SHIELD
FLR9191OtherBLUE CROSS BLUE SHIELD