Provider Demographics
NPI:1164881470
Name:ADVANCED MODIFICATIONS, INC.
Entity Type:Organization
Organization Name:ADVANCED MODIFICATIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-848-8226
Mailing Address - Street 1:1766 HAMMOND ST
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1119
Mailing Address - Country:US
Mailing Address - Phone:207-848-8226
Mailing Address - Fax:207-848-8227
Practice Address - Street 1:1766 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-1119
Practice Address - Country:US
Practice Address - Phone:207-848-8226
Practice Address - Fax:207-848-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies