NPIMap

Organization Active NPI

Advant Edge Pharmacy, Inc

  • Durable Medical Equipment & Medical Supplies
  • El Paso, TX
National Provider Identifier
1477547552
Registry record updated Sep 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
19378 Issued in TX
Legal business name
ADVANT EDGE PHARMACY, INC
Practice address
1576 Lomaland Dr
El Paso, TX 79935-4202
Phone
(915) 595-0409
Fax
(915) 595-1306
NPI assigned
Sep 6, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Eustacio Rivas Jr., RPH
Title
President
Phone
(915) 595-0409

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 19378 TX Primary
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X 19378 TX
Oxygen Equipment & Supplies (DME) 332BX2000X 19378 TX

Addresses

Primary practice location

1576 Lomaland Dr
El Paso, TX 79935-4202

Mailing address

1576 Lomaland
El Paso, TX 79935
Phone (915) 595-0409

Other identifiers 2

IdentifierTypeStateIssuer
010965401MedicaidTX
016896501MedicaidTX

Other names 1

  • Advant Edge HME Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347235200000",
    "number": "1477547552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1576 LOMALAND",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79935",
            "telephone_number": "915-595-0409",
            "fax_number": "915-595-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1576 LOMALAND DR",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799354202",
            "telephone_number": "915-595-0409",
            "fax_number": "915-595-1306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANT EDGE PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2012-09-10",
        "status": "A",
        "authorized_official_last_name": "RIVAS",
        "authorized_official_first_name": "EUSTACIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "915-595-0409",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "19378",
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "TX",
            "license": "19378",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "TX",
            "license": "19378",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010965401",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016896501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advant Edge HME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.