Healthcare Provider Details

I. General information

NPI: 1407633803
Provider Name (Legal Business Name): ADVANCED BIOMEDICAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 BRIDGELAND DR STE G
BRIDGETON MO
63044-2605
US

IV. Provider business mailing address

3450 BRIDGELAND DR STE G
BRIDGETON MO
63044-2605
US

V. Phone/Fax

Practice location:
  • Phone: 314-356-9912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RACHEAL HANNAH
Title or Position: OFFICE ASSISTANT
Credential:
Phone: 618-979-4610