Provider Demographics
NPI:1477653863
Name:ADVANCED MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-477-8993
Mailing Address - Street 1:1119 S MISSOURI ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1399
Mailing Address - Country:US
Mailing Address - Phone:660-415-0026
Mailing Address - Fax:660-415-0002
Practice Address - Street 1:1119 S MISSOURI ST
Practice Address - Street 2:SUITE D
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1399
Practice Address - Country:US
Practice Address - Phone:660-395-9466
Practice Address - Fax:660-395-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO21394423332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626281703Medicaid
MO626281703Medicaid