Provider Demographics
NPI:1225184526
Name:ADVANCE MEDEQUIP, INC.
Entity Type:Organization
Organization Name:ADVANCE MEDEQUIP, INC.
Other - Org Name:ADVANCE MEDEQUIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-404-6633
Mailing Address - Street 1:333 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6325
Mailing Address - Country:US
Mailing Address - Phone:866-404-6633
Mailing Address - Fax:866-504-6633
Practice Address - Street 1:333 GORDON ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-6325
Practice Address - Country:US
Practice Address - Phone:866-404-6633
Practice Address - Fax:866-504-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001768800Medicaid
FL1313318OtherAHCA
MD430009200Medicaid
MD430009200Medicaid