Provider Demographics
NPI:1396950754
Name:ADVANCED MEDICAL SPECIALTIES
Entity type:Organization
Organization Name:ADVANCED MEDICAL SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-255-1290
Mailing Address - Street 1:236 W EDISON RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3184
Mailing Address - Country:US
Mailing Address - Phone:574-255-1290
Mailing Address - Fax:574-255-1523
Practice Address - Street 1:236 W EDISON RD
Practice Address - Street 2:SUITE F
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3184
Practice Address - Country:US
Practice Address - Phone:574-255-1290
Practice Address - Fax:574-255-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1295070001Medicare ID - Type UnspecifiedPROVIDER NUMBER