MEDICARE: ADVANCED MEDICAL SUPPLY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	4193730002	PR
2	332BX2000X	Oxygen Equipment & Supplies (DME)	4193730001	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50089	OTHER	PR	PMC

General Provider Information

NPI Number	:	1083742043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL SUPPLY CORP

Provider Business Mailing Address
First Line	:	HC 3 BOX 24071
Second Line	:
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-9736
Country	:	US
Telephone Number	:	787-892-6780
Fax Number	:	787-892-6684

Provider Business Practice Location Address
First Line	:	64 CALLE SAN CARLOS
Second Line	:
City	:	QUEBRADILLAS
State	:	PR
Zip	:	00678-1734
Country	:	US
Telephone Number	:	787-895-0666
Fax Number	:	787-895-8700

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSE E ESTEVEZ
Credential	:
Telephone Number	:	787-364-6620

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	10/16/2014

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Directions to “ADVANCED MEDICAL SUPPLY CORP ” Practice Location

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