Provider Demographics
NPI:1912936980
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:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:DOPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-998-9999
Mailing Address - Street 1:213 EXPO CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292
Mailing Address - Country:US
Mailing Address - Phone:318-998-9999
Mailing Address - Fax:318-998-6004
Practice Address - Street 1:213 EXPO CIRCLE
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292
Practice Address - Country:US
Practice Address - Phone:318-998-9999
Practice Address - Fax:318-998-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1621102Medicaid
=========0OtherBCBS
LA1621102Medicaid