Healthcare Provider Details

I. General information

NPI: 1366691875
Provider Name (Legal Business Name): ADVANCED CPAP SUPPLIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3388B MERLIN RD NUMBER 304
GRANTS PASS OR
97526-8421
US

IV. Provider business mailing address

3388B MERLIN RD NUMBER 304
GRANTS PASS OR
97526-8421
US

V. Phone/Fax

Practice location:
  • Phone: 541-646-0737
  • Fax:
Mailing address:
  • Phone: 541-646-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number541997-90
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ROBERT LEWIS HUMMEL III
Title or Position: PRESIDENT
Credential: RPSGT
Phone: 541-646-0737