Provider Demographics
NPI:1699957175
Name:ADVANTAGE MOBILITY LLC
Entity type:Organization
Organization Name:ADVANTAGE MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:MARLOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-946-1203
Mailing Address - Street 1:5723 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3385
Mailing Address - Country:US
Mailing Address - Phone:336-946-1203
Mailing Address - Fax:336-946-1206
Practice Address - Street 1:5723 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3385
Practice Address - Country:US
Practice Address - Phone:336-946-1203
Practice Address - Fax:336-946-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01382332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6096280001Medicare NSC