Provider Demographics
NPI:1124256458
Name:ADVANCED MEDICAL SUPPLIES, LLC
Entity type:Organization
Organization Name:ADVANCED MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-410-2564
Mailing Address - Street 1:7 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401
Mailing Address - Country:US
Mailing Address - Phone:203-736-1712
Mailing Address - Fax:203-736-1738
Practice Address - Street 1:7 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2201
Practice Address - Country:US
Practice Address - Phone:203-736-1712
Practice Address - Fax:203-736-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========OtherEIN