Provider Demographics
NPI:1437874591
Name:ADVANCED LYMPHEDEMA SPECIALISTS
Entity Type:Organization
Organization Name:ADVANCED LYMPHEDEMA SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-212-9098
Mailing Address - Street 1:2657 GREENVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6401
Mailing Address - Country:US
Mailing Address - Phone:713-212-9098
Mailing Address - Fax:866-502-2826
Practice Address - Street 1:1521 S STAPLES ST STE 401
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3152
Practice Address - Country:US
Practice Address - Phone:361-333-5472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty