Healthcare Provider Details

I. General information

NPI: 1912900978
Provider Name (Legal Business Name): ADVANCED MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 W BROAD ST
COLUMBUS OH
43228-1602
US

IV. Provider business mailing address

4840 W BROAD ST
COLUMBUS OH
43228-1602
US

V. Phone/Fax

Practice location:
  • Phone: 614-870-0111
  • Fax: 614-870-9114
Mailing address:
  • Phone: 614-870-0111
  • Fax: 614-870-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number18
License Number StateOH

VIII. Authorized Official

Name: MS. ANDREA F WELLS
Title or Position: PRESIDENT
Credential:
Phone: 614-870-0111