Provider Demographics
NPI:1205039195
Name:AVANT MEDICAL GROUP PA
Entity Type:Organization
Organization Name:AVANT MEDICAL GROUP PA
Other - Org Name:ALLIED MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:H
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-378-2667
Mailing Address - Street 1:PO BOX 24809
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77229-4809
Mailing Address - Country:US
Mailing Address - Phone:713-785-2667
Mailing Address - Fax:713-987-7815
Practice Address - Street 1:2070 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3102
Practice Address - Country:US
Practice Address - Phone:281-880-6655
Practice Address - Fax:281-880-6659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7979111N00000X
TX7138111N00000X
TX8699111N00000X
TX9330111N00000X
TX7231111N00000X
TX8504111N00000X
TXK7377207R00000X
TX1135762225100000X
TXK4259261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty