Provider Demographics
NPI:1184866709
Name:MARLON PADILLA
Entity Type:Organization
Organization Name:MARLON PADILLA
Other - Org Name:ADVANCED MEDICAL SYSTEMS AND SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:D
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-563-1636
Mailing Address - Street 1:1553 HIGHWAY 34 S
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-4833
Mailing Address - Country:US
Mailing Address - Phone:972-563-1636
Mailing Address - Fax:972-563-3799
Practice Address - Street 1:1553 HIGHWAY 34 S
Practice Address - Street 2:SUITE # 300
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-4833
Practice Address - Country:US
Practice Address - Phone:972-563-1636
Practice Address - Fax:972-563-3799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARLON PADILLA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2254173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080352001Medicaid
A93480Medicare UPIN