Organization
ADVACARE MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREL B STEVENS CRTS (PRESIDENT)
(913) 780-4700
Entity
Organization
Contact information
Practice address
938A S OLIVER ST, WICHITA, KS 67218-3216
(316) 440-5550
(316) 440-5552
Mailing address
14801 W 117TH ST, OLATHE, KS 66062-9305
(913) 780-4700
(913) 780-4776
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100441790A
—
KS
Enumeration date
12/08/2006
Last updated
04/12/2012
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