Provider Demographics
NPI:1598913972
Name:ADVANTAGE MEDICAL INFUSION LLC
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL INFUSION LLC
Other - Org Name:AMI RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-408-1251
Mailing Address - Street 1:5296 OLD HIGHWAY 11
Mailing Address - Street 2:SUITE4
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8380
Mailing Address - Country:US
Mailing Address - Phone:601-450-0294
Mailing Address - Fax:601-450-0295
Practice Address - Street 1:5296 OLD HIGHWAY 11
Practice Address - Street 2:SUITE 4
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8380
Practice Address - Country:US
Practice Address - Phone:601-450-0294
Practice Address - Fax:601-450-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN64001757A3336C0003X
DEA9-00015093336C0003X
IA43653336C0003X
MDP064643336C0003X
KS22-446113336C0003X
FLPH282113336C0003X
CTPCN.00027833336C0003X
KYMS18203336C0003X
LAPHY.006947-NR3336C0003X
IL054.0187963336C0003X
AK14713336C0003X
ID36488MS3336C0003X
MEMO400017113336C0003X
CANRP15453336C0003X
COOSP.00064713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08200210Medicaid
2145322OtherPK