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General NPI Number Information
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NPI Number | 1053647842
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Entity Type | Organization
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Legal Business Name | ADVANCE MEDICAL SERVICES
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 6448 E HWY 290 SUITE B102
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City | AUSTIN
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State | TX
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Zip | 78723-1068
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Country | US
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Telephone | 512-371-8876
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Fax |
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Provider Business Mailing Address
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Address Line | 6448 E HWY 290 SUITE B102
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City | AUSTIN
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State | TX
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Zip | 78723-1068
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Country | US
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Telephone | 512-371-8876
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Fax |
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Authorized Official
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Title or Position | PRES.
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Name | KENNETH GOSSIP
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Credential |
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Telephone | 512-371-8876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0078307
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License Number State | TX
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