Provider Demographics
NPI:1750468013
Name:ADVANCED SEATING AND MOBILITY, INC.
Entity Type:Organization
Organization Name:ADVANCED SEATING AND MOBILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDURU-RAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-782-5110
Mailing Address - Street 1:8800 WESTGATE PARK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617
Mailing Address - Country:US
Mailing Address - Phone:919-782-5110
Mailing Address - Fax:919-782-7232
Practice Address - Street 1:8800 WESTGATE PARK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617
Practice Address - Country:US
Practice Address - Phone:919-782-5110
Practice Address - Fax:919-782-7232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3418832332B00000X
332BC3200X
NC01115332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704469Medicaid
NC0460UOtherNC BCBS PROVIDER ID #
NC3418832OtherCAP
NC3418832OtherCAP
NC0460UOtherNC BCBS PROVIDER ID #
NC5666830001Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #