Provider Demographics
NPI:1174861066
Name:ADVANTAGE MEDICAL CLINIC
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-943-9431
Mailing Address - Street 1:PO BOX 226656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-6656
Mailing Address - Country:US
Mailing Address - Phone:214-913-9431
Mailing Address - Fax:214-943-9407
Practice Address - Street 1:1102 SOLON PLACE WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5038
Practice Address - Country:US
Practice Address - Phone:972-351-9993
Practice Address - Fax:972-351-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty