Healthcare Provider Details

I. General information

NPI: 1629137260
Provider Name (Legal Business Name): ADVACARE MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938A S OLIVER ST
WICHITA KS
67218-3216
US

IV. Provider business mailing address

14801 W 117TH ST
OLATHE KS
66062-9305
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-5550
  • Fax: 316-440-5552
Mailing address:
  • Phone: 913-780-4700
  • Fax: 913-780-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JEREL B STEVENS
Title or Position: PRESIDENT
Credential: CRTS
Phone: 913-780-4700