MEDICARE: ADVANCED HEALING SYSTEMS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1518149137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HEALING SYSTEMS, LLC

Provider Business Mailing Address
First Line	:	7801 E BUSH LAKE RD
Second Line	:	SUITE 475
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55439-3120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7801 E BUSH LAKE RD
Second Line	:	SUITE 475
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55439-3120
Country	:	US
Telephone Number	:	952-230-2122
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TOM SPENCER
Credential	:
Telephone Number	:	952-230-2122

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/05/2007

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