Provider Demographics
NPI:1093002305
Name:ADVOCATE MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ADVOCATE MEDICAL SERVICES, LLC
Other - Org Name:ACTIVSTYLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
Mailing Address - Street 1:1701 BROADWAY ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2638
Mailing Address - Country:US
Mailing Address - Phone:800-651-6223
Mailing Address - Fax:866-896-7171
Practice Address - Street 1:2615 E END BLVD S
Practice Address - Street 2:SUITE 285
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-7425
Practice Address - Country:US
Practice Address - Phone:813-280-6538
Practice Address - Fax:903-935-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312723332B00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2856056Medicaid
LA2357336Medicaid
TX2856056Medicaid