MEDICARE: ADVANCED MEDICAL DEVICES, 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

General Provider Information

NPI Number	:	1811063563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL DEVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2004
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37621-2004
Country	:	US
Telephone Number	:	276-642-0469
Fax Number	:	276-466-4848

Provider Business Practice Location Address
First Line	:	1788 ISLAND RD
Second Line	:	SUITE B
City	:	BRISTOL
State	:	VA
Zip	:	24201-7508
Country	:	US
Telephone Number	:	276-642-0469
Fax Number	:	276-466-4848

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ROBERT MCILWAIN
Credential	:
Telephone Number	:	276-642-0469

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	08/22/2020

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