Provider Demographics
NPI:1700116746
Name:ADVENT MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:ADVENT MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:BOURONICH
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:843-597-2264
Mailing Address - Street 1:1223 REMOUNT RD.
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-3418
Mailing Address - Country:US
Mailing Address - Phone:843-277-0077
Mailing Address - Fax:803-753-9699
Practice Address - Street 1:1223 REMOUNT RD.
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-3418
Practice Address - Country:US
Practice Address - Phone:843-277-0077
Practice Address - Fax:803-753-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC30130241Medicaid
S1381OtherBOC ACCREDITATION NUMBER
C53596OtherCERTIFIED ORTHOTIC FITTER LICENSE