Provider Demographics
NPI:1710980693
Name:ADVANCED MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:850-422-3777
Mailing Address - Street 1:1915 WELBY WAY
Mailing Address - Street 2:STE 4
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4595
Mailing Address - Country:US
Mailing Address - Phone:850-422-3777
Mailing Address - Fax:850-385-6403
Practice Address - Street 1:1915 WELBY WAY
Practice Address - Street 2:STE 4
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4595
Practice Address - Country:US
Practice Address - Phone:850-422-3777
Practice Address - Fax:850-385-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5012760001Medicare ID - Type Unspecified