MEDICARE: ADVANCED MEDICAL SUPPLY, 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	335E00000X	Prosthetic/Orthotic Supplier	18	OH
2	332B00000X	Durable Medical Equipment & Medical Supplies		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000155125	OTHER	OH	ANTHEM
2	0975476	OTHER	OH	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912900978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	4840 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1602
Country	:	US
Telephone Number	:	614-870-0111
Fax Number	:	614-870-9114

Provider Business Practice Location Address
First Line	:	4840 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1602
Country	:	US
Telephone Number	:	614-870-0111
Fax Number	:	614-870-9114

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ANDREA F WELLS
Credential	:
Telephone Number	:	614-870-0111

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/13/2019

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