Advanced Home Med, LLC

Key facts

NPI

1992734859

Entity type

Organization (NPI type 2)

Primary specialty

Durable Medical Equipment & Medical Supplies 332B00000X

License

DME166 (ID)

Legal business name

ADVANCED HOME MED, LLC

Practice address

5624 N Government Way
Ste 6
Dalton GDNS, ID 83815-7350

Phone

(208) 772-9111

Fax

(208) 772-9114

NPI assigned

Jul 2, 2006

Organization subpart

No

Authorized official

Name

Mrs. Kami L Davis

Title

Partner Owner

Phone

(208) 772-9111

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 2, 2010.

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267488000000",
    "number": "1992734859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5624 N GOVERNMENT WAY",
            "address_2": "STE 6",
            "city": "DALTON GDNS",
            "state": "ID",
            "postal_code": "838157350",
            "telephone_number": "208-772-9111",
            "fax_number": "208-772-9114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5624 N GOVERNMENT WAY",
            "address_2": "STE 6",
            "city": "DALTON GDNS",
            "state": "ID",
            "postal_code": "838157350",
            "telephone_number": "208-772-9111",
            "fax_number": "208-772-9114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED HOME MED, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2010-03-02",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KAMI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PARTNER OWNER",
        "authorized_official_telephone_number": "208-772-9111",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "ID",
            "license": "DME166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BS OF ID",
            "identifier": "000010137820",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100502494",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806024600",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ID",
            "identifier": "CC8203",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ID",
            "identifier": "8I227",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9054859",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}