Provider Demographics
NPI:1073572152
Name:ADVANCED HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BRANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, ACNP, FNP
Authorized Official - Phone:713-729-2245
Mailing Address - Street 1:4429 BRIARBEND DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-5003
Mailing Address - Country:US
Mailing Address - Phone:713-729-2245
Mailing Address - Fax:713-729-9853
Practice Address - Street 1:4429 BRIARBEND DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-5003
Practice Address - Country:US
Practice Address - Phone:713-729-2245
Practice Address - Fax:713-729-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-19
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00210174400000X
TX587893363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS81260Medicare UPIN