Provider Demographics
NPI:1083742043
Name:ADVANCED MEDICAL SUPPLY CORP
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SUPPLY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESTEVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-364-6620
Mailing Address - Street 1:HC 3 BOX 24071
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9736
Mailing Address - Country:US
Mailing Address - Phone:787-892-6780
Mailing Address - Fax:787-892-6684
Practice Address - Street 1:64 CALLE SAN CARLOS
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-1734
Practice Address - Country:US
Practice Address - Phone:787-895-0666
Practice Address - Fax:787-895-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4193730001332BX2000X
PR4193730002332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50089OtherPMC
PR4193730001Medicare NSC
PR4193730002Medicare NSC