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Organization

ADVANCED MEDICAL INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAVID L ROUSH (PRESIDENT)
(304) 776-4318
Entity
Organization

Contact information

Practice address
128 GOFF MOUNTAIN RD, CROSS LANES, WV 25313-1435
(304) 776-2002
(304) 776-2004
Mailing address
PO BOX 7532, CHARLESTON, WV 25356-0532
(304) 776-2002
(304) 776-2004

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
332BC3200X
Customized Equipment (DME)
Primary
332BX2000X
Oxygen Equipment & Supplies (DME)

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
9226145
AETNA
WV
Enumeration date
09/26/2007
Last updated
04/23/2013
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