Provider Demographics
NPI:1053647842
Name:ADVANCE MEDICAL SERVICES
Entity Type:Organization
Organization Name:ADVANCE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-371-8876
Mailing Address - Street 1:6448 E HWY 290
Mailing Address - Street 2:SUITE B102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1068
Mailing Address - Country:US
Mailing Address - Phone:512-371-8876
Mailing Address - Fax:
Practice Address - Street 1:6448 E HWY 290
Practice Address - Street 2:SUITE B102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1068
Practice Address - Country:US
Practice Address - Phone:512-371-8876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0078307332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016458401Medicaid
TX1057820002Medicare NSC