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NPI Code Detail

MEDICARE: ADVANCED DURABLE MEDICAL, INC.

MEDICARE: ADVANCED DURABLE MEDICAL, INC.
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
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1255475547
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED DURABLE MEDICAL, INC.
Provider Business Mailing Address
First Line : 2054 CONCOURSE DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4119
Country : US
Telephone Number : 314-447-0259
Fax Number : 314-447-0263
Provider Business Practice Location Address
First Line : 2054 CONCOURSE DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4119
Country : US
Telephone Number : 314-447-0259
Fax Number : 314-447-0263
Authorized Official
Title or Position : PRESIDENT
Name : MR. GARY CARLON CANTRELL
Credential :
Telephone Number : 314-447-0259
Provider Enumeration Date : 02/19/2007
Last Update Date : 08/22/2020

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Directions to “ADVANCED DURABLE MEDICAL, INC. ” Practice Location

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