Provider Demographics
NPI:1659441467
Name:ADVANCEMEDICAL SUPPLY
Entity Type:Organization
Organization Name:ADVANCEMEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:MORSHETTE
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-703-9451
Mailing Address - Street 1:1303 W BUCKINGHAM RD STE#115
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044
Mailing Address - Country:US
Mailing Address - Phone:214-703-9451
Mailing Address - Fax:214-703-9452
Practice Address - Street 1:1303 W BUCKINGHAM RD STE 115
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-4574
Practice Address - Country:US
Practice Address - Phone:214-703-9451
Practice Address - Fax:214-703-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0086322332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180037701Medicaid
TX180037702Medicaid
TX5637090001Medicare NSC