Provider Demographics
NPI:1538141643
Name:ADVANTAGE MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-452-4013
Mailing Address - Street 1:3701 NAMEOKI RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3711
Mailing Address - Country:US
Mailing Address - Phone:618-452-4013
Mailing Address - Fax:618-452-4726
Practice Address - Street 1:3701 NAMEOKI RD
Practice Address - Street 2:SUITE A
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3711
Practice Address - Country:US
Practice Address - Phone:618-452-4013
Practice Address - Fax:618-452-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========0001Medicaid
IL=========0001Medicaid