Provider Demographics
NPI:1518086925
Name:ADVANCED SPINE & SPORTS MEDICINE
Entity Type:Organization
Organization Name:ADVANCED SPINE & SPORTS MEDICINE
Other - Org Name:ALEXANDER HEALTH SERVICES,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BIJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOSTAEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-9686
Mailing Address - Street 1:4801 SPRING VALLEY RD
Mailing Address - Street 2:SUITE 40
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3956
Mailing Address - Country:US
Mailing Address - Phone:972-488-9686
Mailing Address - Fax:972-241-1936
Practice Address - Street 1:4801 SPRING VALLEY RD
Practice Address - Street 2:SUITE 40
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3956
Practice Address - Country:US
Practice Address - Phone:972-488-9686
Practice Address - Fax:972-241-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6832111NS0005X
TXDC9801111NS0005X
TXDC10069111NS0005X
TXPT1126068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty