Provider Demographics
NPI:1154137909
Name:ADVANTAGE MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:ADVANTAGE MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-807-9395
Mailing Address - Street 1:670 S HIGHWAY 89A # 89A
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3680
Mailing Address - Country:US
Mailing Address - Phone:801-831-0939
Mailing Address - Fax:
Practice Address - Street 1:355 W MESQUITE BLVD STE C10
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8117
Practice Address - Country:US
Practice Address - Phone:702-997-4228
Practice Address - Fax:888-775-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies