Provider Demographics
NPI:1497717235
Name:ADVANTAGE HOME MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:ADVANTAGE HOME MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZEZULAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-579-5790
Mailing Address - Street 1:911 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6628
Mailing Address - Country:US
Mailing Address - Phone:708-579-5790
Mailing Address - Fax:708-579-1384
Practice Address - Street 1:911 W 55TH ST
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-6628
Practice Address - Country:US
Practice Address - Phone:708-579-5790
Practice Address - Fax:708-579-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000326332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203000326OtherILLINOIS HME PROVIDER LIC
IL=========001Medicaid
IL4294180001Medicare NSC