Provider Demographics
NPI:1629137260
Name:ADVACARE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ADVACARE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREL
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:CRTS
Authorized Official - Phone:913-780-4700
Mailing Address - Street 1:14801 W 117TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-9305
Mailing Address - Country:US
Mailing Address - Phone:913-780-4700
Mailing Address - Fax:913-780-4776
Practice Address - Street 1:938A S OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3216
Practice Address - Country:US
Practice Address - Phone:316-440-5550
Practice Address - Fax:316-440-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100441790AMedicaid
KS0257930003Medicare NSC