Provider Demographics
NPI:1790080877
Name:ADVANTAGE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:LUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-750-7555
Mailing Address - Street 1:8902 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-2105
Mailing Address - Country:US
Mailing Address - Phone:520-750-7555
Mailing Address - Fax:520-750-1754
Practice Address - Street 1:8902 E 39TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-2105
Practice Address - Country:US
Practice Address - Phone:520-750-7555
Practice Address - Fax:520-750-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0167476332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies