Provider Demographics
NPI:1275655854
Name:ADVANCE ONE MEDICAL EQUIPMENT & SUPPLIES LLC.
Entity Type:Organization
Organization Name:ADVANCE ONE MEDICAL EQUIPMENT & SUPPLIES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ZABRINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KRUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-549-1113
Mailing Address - Street 1:1700 OLD MINDEN RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-4820
Mailing Address - Country:US
Mailing Address - Phone:318-549-1113
Mailing Address - Fax:318-549-3331
Practice Address - Street 1:1700 OLD MINDEN RD
Practice Address - Street 2:SUITE 116
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4820
Practice Address - Country:US
Practice Address - Phone:318-549-1113
Practice Address - Fax:318-549-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5017108001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1100102Medicaid
SC4250760001Medicare ID - Type Unspecified