MEDICARE: ADVENT MEDICAL SUPPLIES LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	S1381	OTHER	BOC ACCREDITATION NUMBER
3	C53596	OTHER	CERTIFIED ORTHOTIC FITTER LICENSE

General Provider Information

NPI Number	:	1700116746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVENT MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	1223 REMOUNT RD.
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-3418
Country	:	US
Telephone Number	:	843-277-0077
Fax Number	:	803-753-9699

Provider Business Practice Location Address
First Line	:	1223 REMOUNT RD.
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-3418
Country	:	US
Telephone Number	:	843-277-0077
Fax Number	:	803-753-9699

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MR. ROBERT BRIAN BOURONICH
Credential	:	COF
Telephone Number	:	843-597-2264

Provider Enumeration Date	:	01/13/2010
Last Update Date	:	06/23/2021

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Directions to “ADVENT MEDICAL SUPPLIES LLC ” Practice Location

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