Active NPI
Advanced Tissue, LLC
Doing business as Advanced Tissue
- Durable Medical Equipment & Medical Supplies
- Little Rock, AR
National Provider Identifier
1962515783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- ADVANCED TISSUE, LLC
- Doing business as
- Advanced Tissue
- Practice address
- 7003 Valley Ranch Dr
Little Rock, AR 72223-4696 - Phone
- (501) 217-9900
- Fax
- (501) 217-9939
- NPI assigned
- Aug 16, 2006
- Last updated
- Oct 2, 2015
- Organization subpart
- Yes
- Parent organization
- AT BUYER, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Douglas Kevin Lamb
- Title
- Chief Executive Officer
- Phone
- (501) 217-9900
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Primary |
Addresses
Primary practice location
7003 Valley Ranch Dr
Little Rock, AR 72223-4696
Mailing address
7003 Valley Ranch Dr
Little Rock, AR 72223-4696
Phone (501) 217-9900
Other identifiers 18
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0563775 | Medicaid | IA | |
| 806569500 | Medicaid | ID | |
| 90003740 | Medicaid | KY | |
| 984669700 | Medicaid | MN | |
| 0440992 | Medicaid | MS | |
| 431825000 | Medicaid | ME | |
| 733982 | Medicaid | AZ | |
| MS151AR | Medicaid | AK | |
| 143955716 | Medicaid | AR | |
| 874487746 | Medicaid | MI | |
| 009966110 | Medicaid | AL | |
| 200446340A | Medicaid | IN | |
| 34637036 | Medicaid | CO | |
| 0031177 | Medicaid | CT | |
| 1000037816 | Medicaid | DE | |
| 000979536A | Medicaid | GA | |
| 1153184 | Medicaid | LA | |
| 401946600 | Medicaid | MD |
Other names 1
- Advanced Tissue
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1443744000000",
"number": "1962515783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7003 VALLEY RANCH DR",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722234696",
"telephone_number": "501-217-9900",
"fax_number": "501-217-9939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7003 VALLEY RANCH DR",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722234696",
"telephone_number": "501-217-9900",
"fax_number": "501-217-9939"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVANCED TISSUE, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AT BUYER, INC.",
"enumeration_date": "2006-08-16",
"last_updated": "2015-10-02",
"status": "A",
"authorized_official_last_name": "LAMB",
"authorized_official_first_name": "DOUGLAS",
"authorized_official_middle_name": "KEVIN",
"authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "501-217-9900",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0563775",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806569500",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "90003740",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "984669700",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0440992",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "431825000",
"state": "ME"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "733982",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MS151AR",
"state": "AK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "143955716",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "874487746",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009966110",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200446340A",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "34637036",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0031177",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1000037816",
"state": "DE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000979536A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1153184",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "401946600",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Advanced Tissue",
"code": "3",
"type": "Doing Business As"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.