Provider Demographics
NPI:1275733677
Name:ADVANCED BIOMEDICAL
Entity Type:Organization
Organization Name:ADVANCED BIOMEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:MECKLENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:3147-199-3006
Mailing Address - Street 1:PO BOX 4202
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63006-4202
Mailing Address - Country:US
Mailing Address - Phone:314-719-9300
Mailing Address - Fax:
Practice Address - Street 1:2144 COURTLEIGH LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7623
Practice Address - Country:US
Practice Address - Phone:314-719-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4096730001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4096730001Medicare UPIN