Provider Demographics
NPI: | 1033308226 |
---|---|
Name: | MEDICAL SUPPLY ADVANTAGE LLC |
Entity Type: | Organization |
Organization Name: | MEDICAL SUPPLY ADVANTAGE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | EARL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FLYNN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 317-280-1980 |
Mailing Address - Street 1: | 8649 GORDONSHIRE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46278-2201 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-280-1980 |
Mailing Address - Fax: | 866-592-7989 |
Practice Address - Street 1: | 8649 GORDONSHIRE DR |
Practice Address - Street 2: | |
Practice Address - City: | INDIANAPOLIS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46278-2201 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-280-1980 |
Practice Address - Fax: | 317-280-1980 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-10-24 |
Last Update Date: | 2008-12-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
6025440001 | Medicare NSC |