Provider Demographics
NPI:1407021744
Name:ADVANTAGE MEDICAL AND PHARMACEUTICAL, LLC
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL AND PHARMACEUTICAL, LLC
Other - Org Name:PINE BELT MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-268-1422
Mailing Address - Street 1:6375 U S HIGHWAY 98
Mailing Address - Street 2:SUITE 40
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7410
Mailing Address - Country:US
Mailing Address - Phone:601-268-1422
Mailing Address - Fax:601-268-1424
Practice Address - Street 1:6375 U S HIGHWAY 98 STE 40
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7411
Practice Address - Country:US
Practice Address - Phone:601-268-1422
Practice Address - Fax:601-268-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01184021Medicaid