Provider Demographics
NPI:1184672800
Name:ADVANCED INTEGRATED MEDICAL LLC
Entity Type:Organization
Organization Name:ADVANCED INTEGRATED MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-630-9080
Mailing Address - Street 1:9800A MCKNIGHT RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-6003
Mailing Address - Country:US
Mailing Address - Phone:412-630-9080
Mailing Address - Fax:412-630-9553
Practice Address - Street 1:9800A MCKNIGHT RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-6003
Practice Address - Country:US
Practice Address - Phone:412-630-9080
Practice Address - Fax:412-630-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018131140002Medicaid
PA210469OtherUPMC
PA241952OtherHIGHMARK
PA224581OtherHEALTH AMERICA
PA241952OtherHIGHMARK