Provider Demographics
NPI:1477843126
Name:ADVANCED MEDICAL BROKERAGE
Entity Type:Organization
Organization Name:ADVANCED MEDICAL BROKERAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-859-0185
Mailing Address - Street 1:PO BOX 1117
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-7117
Mailing Address - Country:US
Mailing Address - Phone:215-859-0185
Mailing Address - Fax:
Practice Address - Street 1:14 S YORK RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-3326
Practice Address - Country:US
Practice Address - Phone:215-442-1300
Practice Address - Fax:215-442-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
NJ332B00000X
DE332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies