Provider Demographics
NPI:1447367677
Name:ADVANCE MEDICAL SERVICES
Entity type:Organization
Organization Name:ADVANCE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-458-8393
Mailing Address - Street 1:628 E CENTRE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2499
Mailing Address - Country:US
Mailing Address - Phone:972-458-8393
Mailing Address - Fax:972-458-8304
Practice Address - Street 1:628 E CENTRE PARK BLVD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2499
Practice Address - Country:US
Practice Address - Phone:972-458-8393
Practice Address - Fax:972-458-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1057820001Medicare ID - Type UnspecifiedMEDCR ID