Provider Demographics
NPI:1104820844
Name:ADVANTAGE HOME MEDICAL EQUIPMENT, INC.
Entity type:Organization
Organization Name:ADVANTAGE HOME MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-792-2224
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-0369
Mailing Address - Country:US
Mailing Address - Phone:386-792-2224
Mailing Address - Fax:386-792-2244
Practice Address - Street 1:605 HWY 41 NW
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052
Practice Address - Country:US
Practice Address - Phone:386-792-2224
Practice Address - Fax:386-792-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1175332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR8968OtherBCBS PROVIDER NUMBER
FL951940800Medicaid
FL1192800001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER