Provider Demographics
NPI:1427032291
Name:ADVOCATE MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ADVOCATE MEDICAL SERVICES, LLC
Other - Org Name:ACTIVSTYLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
Mailing Address - Street 1:1701 BROADWAY ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2638
Mailing Address - Country:US
Mailing Address - Phone:800-651-6223
Mailing Address - Fax:866-896-7171
Practice Address - Street 1:5912 BRECKENRIDGE PKWY STE G
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4200
Practice Address - Country:US
Practice Address - Phone:813-280-6543
Practice Address - Fax:877-426-7329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312723332B00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200492890 AMedicaid
MI1427032291Medicaid
TN1513981Medicaid
CT1427032291Medicaid
NM8872554Medicaid
SCDE2783Medicaid
FL001696900Medicaid
KY7100119020Medicaid
NC7705170Medicaid
AZ877946Medicaid
AL009961215Medicaid
IA1427032291Medicaid
MN1427032291Medicaid
LA2357336Medicaid
RI3590001Medicaid
GA572140235AMedicaid
MI1730511965Medicaid
IL20708006001Medicaid
UT20708006001Medicaid
OH2502901Medicaid
NC7704550Medicaid
OK200043720AMedicaid
NE10025792000Medicaid
NM8872554Medicaid