Provider Demographics
NPI:1235595737
Name:BIOADVANCE PROSTHETIC SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:BIOADVANCE PROSTHETIC SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LP
Authorized Official - Phone:972-521-6101
Mailing Address - Street 1:1111 RAINTREE CIR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4901
Mailing Address - Country:US
Mailing Address - Phone:972-521-6101
Mailing Address - Fax:972-521-6102
Practice Address - Street 1:1111 RAINTREE CIR
Practice Address - Street 2:SUITE 150
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4901
Practice Address - Country:US
Practice Address - Phone:972-521-6101
Practice Address - Fax:972-521-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1525224P00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty