Provider Demographics
NPI:1811063563
Name:ADVANCED MEDICAL DEVICES, LLC
Entity type:Organization
Organization Name:ADVANCED MEDICAL DEVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCILWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-642-0469
Mailing Address - Street 1:PO BOX 2004
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37621-2004
Mailing Address - Country:US
Mailing Address - Phone:276-642-0469
Mailing Address - Fax:276-466-4848
Practice Address - Street 1:1788 ISLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-7508
Practice Address - Country:US
Practice Address - Phone:276-642-0469
Practice Address - Fax:276-466-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies