Provider Demographics
NPI:1588733612
Name:ADVANCE HOME OXYGEN & MEDICAL SUPPLY
Entity type:Organization
Organization Name:ADVANCE HOME OXYGEN & MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-841-5540
Mailing Address - Street 1:42 HUDSON ST STE 111
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8505
Mailing Address - Country:US
Mailing Address - Phone:410-841-5540
Mailing Address - Fax:410-224-0009
Practice Address - Street 1:42 HUDSON ST STE 111
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-8505
Practice Address - Country:US
Practice Address - Phone:410-841-5540
Practice Address - Fax:410-224-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD255762OtherMAMSI
MD243208100Medicaid
MD255762OtherMAMSI