Healthcare Provider Details

I. General information

NPI: 1407021744
Provider Name (Legal Business Name): ADVANTAGE MEDICAL AND PHARMACEUTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 U S HIGHWAY 98 STE 40
HATTIESBURG MS
39402-7411
US

IV. Provider business mailing address

6375 U S HIGHWAY 98 SUITE 40
HATTIESBURG MS
39402-7410
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-1422
  • Fax: 601-268-1424
Mailing address:
  • Phone: 601-268-1422
  • Fax: 601-268-1424

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 Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRITTANY N. ROACH
Title or Position: MANAGING PARTNER
Credential:
Phone: 601-268-1422