Provider Demographics
NPI:1427398940
Name:MEDVANTAGE PLUS
Entity Type:Organization
Organization Name:MEDVANTAGE PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRISKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-935-7303
Mailing Address - Street 1:951 BROKEN SOUND PKWY NW
Mailing Address - Street 2:STE 195
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3507
Mailing Address - Country:US
Mailing Address - Phone:800-935-7303
Mailing Address - Fax:561-270-0239
Practice Address - Street 1:951 BROKEN SOUND PKWY NW
Practice Address - Street 2:STE 195
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3507
Practice Address - Country:US
Practice Address - Phone:800-935-7303
Practice Address - Fax:561-270-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7512730001OtherMEDICARE PTAN