Provider Demographics
NPI:1033308226
Name:MEDICAL SUPPLY ADVANTAGE LLC
Entity type:Organization
Organization Name:MEDICAL SUPPLY ADVANTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-280-1980
Mailing Address - Street 1:8649 GORDONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2201
Mailing Address - Country:US
Mailing Address - Phone:317-280-1980
Mailing Address - Fax:866-592-7989
Practice Address - Street 1:8649 GORDONSHIRE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2201
Practice Address - Country:US
Practice Address - Phone:317-280-1980
Practice Address - Fax:317-280-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6025440001Medicare NSC