Provider Demographics
NPI:1598826018
Name:ADVANTAGE INFUSION SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANTAGE INFUSION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-273-6528
Mailing Address - Street 1:8080 TRISTAR DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2823
Mailing Address - Country:US
Mailing Address - Phone:972-815-0461
Mailing Address - Fax:877-302-5251
Practice Address - Street 1:6019 RANDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-5719
Practice Address - Country:US
Practice Address - Phone:210-599-7276
Practice Address - Fax:210-599-8621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161743336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0946816-02Medicaid
TX0145435-01Medicaid
TX0788788-01Medicaid
TX0946816-01Medicaid
0896330001Medicare ID - Type Unspecified