Organization
ADVANCED HOME CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE KALBAUGH (CREDENTIALING SPECIALIST)
(336) 878-8824
Entity
Organization
Contact information
Practice address
105 JACK WHITE DR, KINGSPORT, TN 37664-2364
(423) 230-8485
(800) 311-7783
Mailing address
PO BOX 18049, GREENSBORO, NC 27419-8049
(336) 878-8950
(800) 311-7783
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
TN
332BC3200X
Customized Equipment (DME)
—
TN
332BN1400X
Nursing Facility Supplies (DME)
—
TN
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
0000002963
TN
332BX2000X
Oxygen Equipment & Supplies (DME)
—
TN
333600000X
Pharmacy
0000002963
TN
3336H0001X
Home Infusion Therapy Pharmacy
0000002963
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300795
ANTHEM DME
VA
01
—
301489
ANTHEM IV
VA
01
—
4153574
BCBSTN IV
TN
01
—
4153575
BCBSTN DME
TN
Enumeration date
06/15/2007
Last updated
07/24/2017
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