Provider Demographics
NPI:1861418261
Name:ADVANTAGE MEDICAL, INC.
Entity type:Organization
Organization Name:ADVANTAGE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-845-8841
Mailing Address - Street 1:11110 LINDBERGH BUSINESS CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7810
Mailing Address - Country:US
Mailing Address - Phone:314-845-8841
Mailing Address - Fax:314-845-8843
Practice Address - Street 1:11110 LINDBERGH BUSINESS CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7810
Practice Address - Country:US
Practice Address - Phone:314-845-8841
Practice Address - Fax:314-845-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1070260001Medicare NSC