Provider Demographics
NPI:1154177764
Name:ADVANTAGE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:ADVANTAGE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PROVIDER
Authorized Official - Phone:760-448-0224
Mailing Address - Street 1:42 FAY ST
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-6109
Mailing Address - Country:US
Mailing Address - Phone:760-448-0224
Mailing Address - Fax:
Practice Address - Street 1:501 GREAT RD STE 204
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6833
Practice Address - Country:US
Practice Address - Phone:760-448-0224
Practice Address - Fax:405-832-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty