Healthcare Provider Details

I. General information

NPI: 1497463541
Provider Name (Legal Business Name): ADVANTAGE MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 W 700 N STE 103
LOGAN UT
84321-7801
US

IV. Provider business mailing address

953 W 700 N STE 112
LOGAN UT
84321-7821
US

V. Phone/Fax

Practice location:
  • Phone: 435-770-7181
  • Fax:
Mailing address:
  • Phone: 435-770-7181
  • Fax: 888-775-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: SHANE EVAN MEACHAM
Title or Position: PRESIDENT
Credential:
Phone: 435-757-5154