1811917206 NPI number — ADVANCED NEUROLOGICAL SERVICES LLC

Table of content: (NPI 1811917206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811917206 NPI number — ADVANCED NEUROLOGICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED NEUROLOGICAL SERVICES LLC
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:
6
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:
1811917206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2755 ALTAMESA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76133-5803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-292-2208
Provider Business Mailing Address Fax Number:
817-292-0572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2755 ALTAMESA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76133-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-292-2208
Provider Business Practice Location Address Fax Number:
817-292-0572
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POWELL
Authorized Official First Name:
JOANIE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
817-292-2208

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2251P0200X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 38332 . This is a "BEECHSTREET HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: NTX11 . This is a "NTHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61101 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62308 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 74223 . This is a "BENEFIT PLANNERS-PHCS HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39141 . This is a "FIRST HEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87043 . This is a "FIRST HEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95959 . This is a "PACIFICARE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 48143 . This is a "GROUP AND PENSION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80705 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84146 . This is a "CHAMP VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87265 . This is a "BENESIGHT-UHC HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80314 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 44054 . This is a "GEHA-PHCS HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 37283 . This is a "GALLAGHER BENEFIT ADMIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62413 . This is a "MAIL HANDLERS BENEFIT PLA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 67466 . This is a "PACIFIC LIFE & ANNUITY" identifier . This identifiers is of the category "OTHER".




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