Provider Demographics
NPI:1881698843
Name:ADVANTAGE MEDICAL, INC.
Entity type:Organization
Organization Name:ADVANTAGE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SHERR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-749-8401
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:ONLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23418
Mailing Address - Country:US
Mailing Address - Phone:757-789-5092
Mailing Address - Fax:757-789-5095
Practice Address - Street 1:25328 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:ONLEY
Practice Address - State:VA
Practice Address - Zip Code:23418
Practice Address - Country:US
Practice Address - Phone:757-789-5092
Practice Address - Fax:757-789-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009049332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009131116Medicaid
VA0531600001Medicare NSC