MEDICARE: ADVANCED MEDICAL SUPPLIES OF

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	00613	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801983762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL SUPPLIES OF

Provider Business Mailing Address
First Line	:	1101 NEUSE RIDGE DR
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-5333
Country	:	US
Telephone Number	:	919-550-6663
Fax Number	:	919-550-9546

Provider Business Practice Location Address
First Line	:	1101 NEUSE RIDGE DR
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-5333
Country	:	US
Telephone Number	:	919-550-6663
Fax Number	:	919-550-9546

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLES G VAIL
Credential	:	RRT
Telephone Number	:	919-550-6663

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	11/20/2008

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Directions to “ADVANCED MEDICAL SUPPLIES OF ” Practice Location

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