Medicare Advantage Tech LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

S5034840 Issued in VA

Legal business name

MEDICARE ADVANTAGE TECH LLC

Practice address

4821 Shady Grove Rd
Glen Allen, VA 23059-6004

Phone

(804) 339-5746

Fax

(804) 612-8671

NPI assigned

Apr 28, 2014

Organization subpart

No

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

Authorized official

Name

Winston Felix Devisser

Title

Owner/Member

Phone

(804) 339-5746

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1398643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398643200000",
    "number": "1720498926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4821 SHADY GROVE RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230596004",
            "telephone_number": "804-339-5746",
            "fax_number": "804-612-8671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4821 SHADY GROVE RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230596004",
            "telephone_number": "804-339-5746",
            "fax_number": "804-612-8671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICARE ADVANTAGE TECH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-28",
        "last_updated": "2014-04-28",
        "status": "A",
        "authorized_official_last_name": "DEVISSER",
        "authorized_official_first_name": "WINSTON",
        "authorized_official_middle_name": "FELIX",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "804-339-5746"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "VA",
            "license": "S5034840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Glen Allen, VA
• Providers in Glen Allen, VA by specialty
• Durable Medical Equipment & Medical Supplies in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; 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.