Provider Demographics
NPI:1912900978
Name:ADVANCED MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:F
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-870-0111
Mailing Address - Street 1:4840 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1602
Mailing Address - Country:US
Mailing Address - Phone:614-870-0111
Mailing Address - Fax:614-870-9114
Practice Address - Street 1:4840 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1602
Practice Address - Country:US
Practice Address - Phone:614-870-0111
Practice Address - Fax:614-870-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
OH18335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155125OtherANTHEM
OH0975476OtherAETNA
OH0737475Medicaid
OH0975476OtherAETNA
OH5944032OtherCIGNA
OH=========003OtherMEDICAL MUTUAL OF OHIO
OH=========026OtherCARESOURCE
OH0975476OtherAETNA