Provider Demographics
NPI:1336222967
Name:ADVANTAGE DIABETIC SUPPLY, LLC
Entity Type:Organization
Organization Name:ADVANTAGE DIABETIC SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-939-7275
Mailing Address - Street 1:229 N PARSON ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-6451
Mailing Address - Country:US
Mailing Address - Phone:803-939-7275
Mailing Address - Fax:803-939-7255
Practice Address - Street 1:229 N PARSON ST
Practice Address - Street 2:SUITE 218
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6451
Practice Address - Country:US
Practice Address - Phone:803-939-7275
Practice Address - Fax:803-939-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies