Provider Demographics
NPI:1902982184
Name:ADVANTAGE HOME MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:ADVANTAGE HOME MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:I
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:SR
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:386-792-2224
Mailing Address - Street 1:605 HWY 41 NW
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052
Mailing Address - Country:US
Mailing Address - Phone:386-792-2224
Mailing Address - Fax:386-792-2244
Practice Address - Street 1:263 MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052
Practice Address - Country:US
Practice Address - Phone:678-957-6503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1175332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL951940800Medicaid
GA300038977BMedicaid
GA300038977BMedicaid