Basic Information
| Provider Information | |||||||||
| NPI: | 1336128628 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED MEDICAL CONCEPTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7008 SECURITY BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437294001 | ||||||||
| FaxNumber: | 4102774250 | ||||||||
| Practice Location | |||||||||
| Address1: | 9-H GWYNNS MILL COURT | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109027900 | ||||||||
| FaxNumber: | 4109021740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 04/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | RAY | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4105942600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | R1011 | MD | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 170588100 | 05 | MD | MEDICAID |