Healthcare Provider Details

I. General information

NPI: 1962083733
Provider Name (Legal Business Name): ADVANCED DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 ALMADEN EXPY STE 20
SAN JOSE CA
95118-1557
US

IV. Provider business mailing address

6707 38TH AVE N
SAINT PETERSBURG FL
33710-1536
US

V. Phone/Fax

Practice location:
  • Phone: 408-264-6644
  • Fax:
Mailing address:
  • Phone: 727-800-9958
  • Fax: 855-552-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN COYLE
Title or Position: OWNER
Credential: DC
Phone: 408-396-6644