Provider Demographics
NPI:1407065204
Name:ADVANTAGE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-754-2337
Mailing Address - Street 1:146 WALL ST
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4510
Mailing Address - Country:US
Mailing Address - Phone:910-754-2337
Mailing Address - Fax:910-754-9249
Practice Address - Street 1:146 WALL ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4510
Practice Address - Country:US
Practice Address - Phone:910-754-2337
Practice Address - Fax:910-754-9249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARY LIFT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-21
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00599332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies