Provider Demographics
NPI:1578734315
Name:SINITRAM LLC
Entity Type:Organization
Organization Name:SINITRAM LLC
Other - Org Name:ADVANTAGE HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLEETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-465-1003
Mailing Address - Street 1:415 E. 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-1506
Mailing Address - Country:US
Mailing Address - Phone:319-465-1003
Mailing Address - Fax:319-465-1004
Practice Address - Street 1:415 E. 1ST STREET
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1506
Practice Address - Country:US
Practice Address - Phone:319-465-1003
Practice Address - Fax:319-465-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA153007358332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0501454Medicaid
IA0501454Medicaid