1598826018 NPI number — ADVANTAGE INFUSION SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598826018 NPI number — ADVANTAGE INFUSION SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANTAGE INFUSION SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598826018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8080 TRISTAR DRIVE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75063-2823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-815-0461
Provider Business Mailing Address Fax Number:
877-302-5251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6019 RANDOLPH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78233-5719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-599-7276
Provider Business Practice Location Address Fax Number:
210-599-8621
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GLYNN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-273-6528

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X , with the licence number:  16174 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0946816-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0145435-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0788788-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0946816-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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