Healthcare Provider Details

I. General information

NPI: 1225033129
Provider Name (Legal Business Name): ADVANCED MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 W ELK AVE
DUNCAN OK
73533-1550
US

IV. Provider business mailing address

2145 W ELK AVE
DUNCAN OK
73533-1550
US

V. Phone/Fax

Practice location:
  • Phone: 580-252-4700
  • Fax: 580-252-4205
Mailing address:
  • Phone: 580-252-4700
  • Fax: 580-252-4205

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

VIII. Authorized Official

Name: KEN MILLER
Title or Position: VP FINANCE CFO
Credential:
Phone: 580-251-8554