Organization
ADVANCED HOME MED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAMI L DAVIS (PARTNER OWNER)
(208) 772-9111
Entity
Organization
Contact information
Practice address
5624 N GOVERNMENT WAY, STE 6, DALTON GDNS, ID 83815-7350
(208) 772-9111
(208) 772-9114
Mailing address
5624 N GOVERNMENT WAY, STE 6, DALTON GDNS, ID 83815-7350
(208) 772-9111
(208) 772-9114
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
DME166
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010137820
REGENCE BS OF ID
ID
05
—
100502494
—
NV
05
—
806024600
—
ID
01
—
8I227
BLUE CROSS OF ID
ID
05
—
9054859
—
WA
01
—
CC8203
BCBS OF ID
ID
Enumeration date
07/02/2006
Last updated
03/02/2010
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