Advanced Medical Group, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

ADVANCED MEDICAL GROUP, LLC

Doing business as

Medicine Mart

Practice address

839 Richland Ave W
Aiken, SC 29801-3833

Phone

(803) 649-7437

Fax

(803) 649-2062

NPI assigned

Dec 3, 2014

Last updated

Jun 13, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Vance T Wall, R.PHNPI 1518141753

Title

Ceo / Owner

Phone

(678) 985-7246

Specialties & licenses 4

Addresses

Other names 1

• Medicine Mart Doing business as

Medicare fee-for-service enrollment

Enrolled in SC2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Drew's Drugs Inc.

  dba Langley Drug

  • Community/Retail Pharmacy
  • Langley, SC
  • NPI 1659346542

  0547337784

  Same PAC ID
• TDS Georgia, LLC

  dba Thomas Drug Store

  • Community/Retail Pharmacy
  • Thomasville, GA
  • NPI 1417980426

  0547337784

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Drew's Drugs Inc.

  dba Langley Drug

  • Community/Retail Pharmacy
  • Langley, SC
  • NPI 1659346542

  O20250603000185

  Same enrollment

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vance Timothy Wall Sr., R.PH.

  • Pharmacist
  • Langley, SC
  • NPI 1518141753
  Authorized official Same address or phone

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560384000000",
    "number": "1912304197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1860",
            "city": "LANGLEY",
            "state": "SC",
            "postal_code": "298341860",
            "telephone_number": "803-593-3411",
            "fax_number": "888-273-1488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "839 RICHLAND AVE W",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298013833",
            "telephone_number": "803-649-7437",
            "fax_number": "803-649-2062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2019-06-13",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "VANCE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO / OWNER",
        "authorized_official_telephone_number": "678-985-7246",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Mart",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medicine Mart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Aiken, SC
• Providers in Aiken, SC by specialty
• Community/Retail Pharmacy in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.