Provider Demographics
NPI:1023726171
Name:ADVANTAGE MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:ADVANTAGE MEDICAL SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:MEACHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-734-0488
Mailing Address - Street 1:953 W 700 N STE 103
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-7801
Mailing Address - Country:US
Mailing Address - Phone:435-770-7181
Mailing Address - Fax:888-775-8787
Practice Address - Street 1:2880 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-6001
Practice Address - Country:US
Practice Address - Phone:385-290-9527
Practice Address - Fax:888-775-8787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANTAGE MEDICAL SUPPLY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-08
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies