Provider Demographics
NPI:1366435505
Name:ADVANCED THERAPY SURFACES, INC.
Entity type:Organization
Organization Name:ADVANCED THERAPY SURFACES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:651-762-1717
Mailing Address - Street 1:2495 MAPLEWOOD DR
Mailing Address - Street 2:SUITE 314
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1913
Mailing Address - Country:US
Mailing Address - Phone:651-762-1717
Mailing Address - Fax:651-762-8549
Practice Address - Street 1:2495 MAPLEWOOD DR
Practice Address - Street 2:SUITE 314
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1913
Practice Address - Country:US
Practice Address - Phone:651-762-1717
Practice Address - Fax:651-762-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN627682200Medicaid
MN58G85ADOtherBCBS DME PROVIDER NUMBER
MN627682200Medicaid
MN58G85ADOtherBCBS DME PROVIDER NUMBER