MEDICARE: ADVANTAGE HOME MEDICAL EQUIPMENT, 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	203000326	IL
2	332BX2000X	Oxygen Equipment & Supplies (DME)	203000326	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	203000326	OTHER	IL	ILLINOIS HME PROVIDER LIC

General Provider Information

NPI Number	:	1497717235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE HOME MEDICAL EQUIPMENT, INC

Provider Business Mailing Address
First Line	:	911 W 55TH ST
Second Line	:
City	:	COUNTRYSIDE
State	:	IL
Zip	:	60525-6628
Country	:	US
Telephone Number	:	708-579-5790
Fax Number	:	708-579-1384

Provider Business Practice Location Address
First Line	:	911 W 55TH ST
Second Line	:
City	:	COUNTRYSIDE
State	:	IL
Zip	:	60525-6628
Country	:	US
Telephone Number	:	708-579-5790
Fax Number	:	708-579-1384

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL S ZEZULAK
Credential	:
Telephone Number	:	708-579-5790

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	04/20/2008

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