Provider Demographics
NPI:1609079581
Name:ADVANCED MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-668-6331
Mailing Address - Street 1:1187 S HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63389-3401
Mailing Address - Country:US
Mailing Address - Phone:636-668-6331
Mailing Address - Fax:
Practice Address - Street 1:1187 S HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:MO
Practice Address - Zip Code:63389-3401
Practice Address - Country:US
Practice Address - Phone:636-668-6331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies