Provider Demographics
NPI:1194728782
Name:ADVANCED MEDICAL TECHNOLOGIES, INC.
Entity type:Organization
Organization Name:ADVANCED MEDICAL TECHNOLOGIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-588-2010
Mailing Address - Street 1:5306 N MIDDLEBROOK PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-5910
Mailing Address - Country:US
Mailing Address - Phone:865-588-2010
Mailing Address - Fax:865-584-0710
Practice Address - Street 1:5306 N MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5910
Practice Address - Country:US
Practice Address - Phone:865-588-2010
Practice Address - Fax:865-584-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000657332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454183Medicaid
TN7316377OtherAETNA
TN4019590OtherBLUE CROSS BLUE SHIELD
TN1454183Medicaid