Provider Demographics
NPI:1417253998
Name:ADVANCE MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:ADVANCE MEDICAL SERVICES INC
Other - Org Name:PETERSEN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAPPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-373-1010
Mailing Address - Street 1:1268 S 1380 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-4911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6602 S STATE ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7221
Practice Address - Country:US
Practice Address - Phone:801-261-9137
Practice Address - Fax:801-261-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1310120007Medicare NSC