Provider Demographics
NPI:1023044799
Name:ADVANTAGE MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOATNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:662-842-8400
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:38869-0307
Mailing Address - Country:US
Mailing Address - Phone:662-842-8400
Mailing Address - Fax:662-680-4700
Practice Address - Street 1:2445 MCCULLOUGH BLVD
Practice Address - Street 2:
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-9742
Practice Address - Country:US
Practice Address - Phone:662-842-8400
Practice Address - Fax:662-680-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies