Provider Demographics
NPI:1295026763
Name:ADVANCED MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:SUDDUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-479-4963
Mailing Address - Street 1:1010 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-5227
Mailing Address - Country:US
Mailing Address - Phone:601-479-4963
Mailing Address - Fax:601-453-5176
Practice Address - Street 1:1010 19TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-5227
Practice Address - Country:US
Practice Address - Phone:601-479-4963
Practice Address - Fax:601-453-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies