Provider Demographics
NPI:1346718590
Name:ADVANCED ILLNESS MANAGEMENT CONSULTING
Entity Type:Organization
Organization Name:ADVANCED ILLNESS MANAGEMENT CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-644-6496
Mailing Address - Street 1:107 GRANBERRY ST
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4547
Mailing Address - Country:US
Mailing Address - Phone:832-644-6496
Mailing Address - Fax:832-644-6499
Practice Address - Street 1:107 GRANBERRY ST
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4547
Practice Address - Country:US
Practice Address - Phone:832-644-6496
Practice Address - Fax:832-644-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty