Provider Demographics
NPI:1073510970
Name:ADVANTAGE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-573-4900
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-8326
Mailing Address - Country:US
Mailing Address - Phone:817-573-4900
Mailing Address - Fax:817-573-0770
Practice Address - Street 1:211 WESTERN HILLS TRL
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-6711
Practice Address - Country:US
Practice Address - Phone:817-573-4900
Practice Address - Fax:817-573-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0052005332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4028860001Medicare ID - Type Unspecified