Provider Demographics
NPI:1790328631
Name:MEDVANTAGE ORTHOCARE, LLC
Entity Type:Organization
Organization Name:MEDVANTAGE ORTHOCARE, LLC
Other - Org Name:MEDVANTAGE DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:IOELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-233-6781
Mailing Address - Street 1:11643 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3656
Mailing Address - Country:US
Mailing Address - Phone:562-233-6781
Mailing Address - Fax:562-941-4767
Practice Address - Street 1:11643 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3656
Practice Address - Country:US
Practice Address - Phone:562-233-6781
Practice Address - Fax:562-941-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies