Provider Demographics
NPI:1235158106
Name:ADVANTAGE MEDICAL SUPPLIES CORP
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL SUPPLIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:YACOV
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLPNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-932-1055
Mailing Address - Street 1:8205 SANTA MONICA BLVD
Mailing Address - Street 2:# 1-464
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:323-932-1055
Mailing Address - Fax:323-932-1017
Practice Address - Street 1:425 S FAIRFAX AVE STE 306
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3148
Practice Address - Country:US
Practice Address - Phone:323-932-1055
Practice Address - Fax:323-932-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102958332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1112940001Medicare ID - Type Unspecified