Provider Demographics
NPI:1124366232
Name:ADVANCED NEURO SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ADVANCED NEURO SOLUTIONS, LLC
Other - Org Name:ANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TRASE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-675-0905
Mailing Address - Street 1:4516 LOVERS LN
Mailing Address - Street 2:STE. 331
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6925
Mailing Address - Country:US
Mailing Address - Phone:214-675-0905
Mailing Address - Fax:214-317-4888
Practice Address - Street 1:4516 LOVERS LN
Practice Address - Street 2:STE. 331
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6925
Practice Address - Country:US
Practice Address - Phone:214-675-0905
Practice Address - Fax:214-317-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty