Provider Demographics
NPI:1235188483
Name:ADVANCE MEDICAL, LLC
Entity Type:Organization
Organization Name:ADVANCE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:RFO
Authorized Official - Phone:843-383-6685
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1022
Mailing Address - Country:US
Mailing Address - Phone:843-383-6685
Mailing Address - Fax:843-383-6609
Practice Address - Street 1:327 S 5TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5701
Practice Address - Country:US
Practice Address - Phone:843-383-6685
Practice Address - Fax:843-383-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2341Medicaid
SCDE2341Medicaid