Provider Demographics
NPI:1275536526
Name:ADVANCED NEUROLOGICAL SERVICES OF DALLAS
Entity Type:Organization
Organization Name:ADVANCED NEUROLOGICAL SERVICES OF DALLAS
Other - Org Name:ADVANCED THERAPY SERVICES OF DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DRO
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-292-2208
Mailing Address - Street 1:13619 INWOOD RD
Mailing Address - Street 2:STE 325
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4643
Mailing Address - Country:US
Mailing Address - Phone:972-386-4375
Mailing Address - Fax:972-386-0451
Practice Address - Street 1:13619 INWOOD RD
Practice Address - Street 2:STE 325
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4643
Practice Address - Country:US
Practice Address - Phone:972-386-4375
Practice Address - Fax:972-386-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64282001261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454816Medicare ID - Type Unspecified