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Contact Information

ADVANCED TISSUE, LLC
7003 VALLEY RANCH DR
LITTLE ROCK, AR72223-4696
 Phone: 501-217-9900
 Fax: 501-217-9939
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for ADVANCED TISSUE, LLC

NPI # 1962515783
LBN Legal business name ADVANCED TISSUE, LLC
Authorized official DOUGLAS LAMB - (CHIEF EXECUTIVE OFFICER)
Entity Organization
Organization subpart 1 Yes
Enumeration date 08/16/2006
Last updated 10/02/2015 - About 11 years ago
Identifiers
AK Medicaid MS151AR
AL Medicaid 009966110
AR Medicaid 143955716
AZ Medicaid 733982
CO Medicaid 34637036
CT Medicaid 0031177
DE Medicaid 1000037816
GA Medicaid 000979536A
IA Medicaid 0563775
ID Medicaid 806569500
IN Medicaid 200446340A
KY Medicaid 90003740
LA Medicaid 1153184
MD Medicaid 401946600
ME Medicaid 431825000
MI Medicaid 874487746
MN Medicaid 984669700
MS Medicaid 0440992
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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