Provider Demographics
NPI:1285860460
Name:ADVANCED HOME MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:ADVANCED HOME MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:HERLOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-900-8388
Mailing Address - Street 1:742 MINK AVE
Mailing Address - Street 2:PMB 742
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6300
Mailing Address - Country:US
Mailing Address - Phone:877-900-8388
Mailing Address - Fax:877-900-8388
Practice Address - Street 1:742 MINK AVE
Practice Address - Street 2:PMB 742
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6300
Practice Address - Country:US
Practice Address - Phone:877-900-8388
Practice Address - Fax:877-900-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies