Provider Demographics
NPI:1801983762
Name:ADVANCED MEDICAL SUPPLIES OF
Entity type:Organization
Organization Name:ADVANCED MEDICAL SUPPLIES OF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:VAIL
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:919-550-6663
Mailing Address - Street 1:1101 NEUSE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-5333
Mailing Address - Country:US
Mailing Address - Phone:919-550-6663
Mailing Address - Fax:919-550-9546
Practice Address - Street 1:1101 NEUSE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-5333
Practice Address - Country:US
Practice Address - Phone:919-550-6663
Practice Address - Fax:919-550-9546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00613332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703456Medicaid
NC4255970001Medicare NSC