Provider Demographics
NPI:1164854527
Name:ADVANCED MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-289-1016
Mailing Address - Street 1:1350 O ST STE 301
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1828
Mailing Address - Country:US
Mailing Address - Phone:559-289-1016
Mailing Address - Fax:559-289-1016
Practice Address - Street 1:1350 O ST STE 301
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1828
Practice Address - Country:US
Practice Address - Phone:559-289-1016
Practice Address - Fax:559-289-1016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH FRESNO PRIMARY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113019332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies