Provider Demographics
NPI:1972526861
Name:ADVANTAGE DIABETIC AND MEDICAL
Entity type:Organization
Organization Name:ADVANTAGE DIABETIC AND MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-661-2238
Mailing Address - Street 1:107 N FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3009
Mailing Address - Country:US
Mailing Address - Phone:251-661-2238
Mailing Address - Fax:251-661-2177
Practice Address - Street 1:107 N FLORIDA ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3009
Practice Address - Country:US
Practice Address - Phone:251-661-2238
Practice Address - Fax:251-661-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL595332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009973425Medicaid
AL51524260OtherBCBS PROVIDER ID
AL51524260OtherBCBS PROVIDER ID