Provider Demographics
NPI:1225033129
Name:ADVANCED MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VP
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:VOLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-251-8554
Mailing Address - Street 1:2185 W ELK AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1550
Mailing Address - Country:US
Mailing Address - Phone:580-252-4700
Mailing Address - Fax:580-252-4205
Practice Address - Street 1:2185 W ELK AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1550
Practice Address - Country:US
Practice Address - Phone:580-252-4700
Practice Address - Fax:580-252-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100812290AMedicaid
OK100812290AMedicaid