Provider Demographics
NPI:1528048766
Name:ADVANCED BRACING AND MEDICAL SUPPLIES
Entity type:Organization
Organization Name:ADVANCED BRACING AND MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMM
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-865-6060
Mailing Address - Street 1:2810 W 35TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2909
Mailing Address - Country:US
Mailing Address - Phone:308-865-6060
Mailing Address - Fax:
Practice Address - Street 1:3000 2ND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847
Practice Address - Country:US
Practice Address - Phone:308-865-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-21
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025191300Medicaid
NE5299190001Medicare NSC