Provider Demographics
NPI:1639277916
Name:ADVANCED MEDICAL SYSTEMS, INC.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-831-0430
Mailing Address - Street 1:PO BOX 10139
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-0139
Mailing Address - Country:US
Mailing Address - Phone:228-831-0430
Mailing Address - Fax:228-831-0421
Practice Address - Street 1:12257A ASHLEY DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2775
Practice Address - Country:US
Practice Address - Phone:228-831-0430
Practice Address - Fax:228-831-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS024303919332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
169064100OtherPROVIDER ID - ACS
1023192OtherPROVIDER ID - ACM
82-0003OtherPROVIDER ID - UHC
MS03987243Medicaid
MS=========OtherTAX ID
MS5398200001Medicare NSC