MEDICARE: ADVANCED HEALING SYSTEMS, 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
1	332B00000X	Durable Medical Equipment & Medical Supplies		MN

General Provider Information

NPI Number	:	1255697959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HEALING SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	7801 E BUSH LAKE RD
Second Line	:	SUITE 475
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55439-3120
Country	:	US
Telephone Number	:	612-767-4600
Fax Number	:	952-487-0149

Provider Business Practice Location Address
First Line	:	7801 E BUSH LAKE RD
Second Line	:	SUITE 475
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55439-3120
Country	:	US
Telephone Number	:	612-767-4600
Fax Number	:	952-487-0149

Authorized Official
Title or Position	:	COO
Name	:	MR. KURT LARSON
Credential	:
Telephone Number	:	612-767-4600

Provider Enumeration Date	:	04/06/2012
Last Update Date	:	04/06/2012

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