Provider Demographics
NPI:1689772790
Name:ADVANCED MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASPRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-238-4112
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-1895
Mailing Address - Country:US
Mailing Address - Phone:281-842-1338
Mailing Address - Fax:281-842-1794
Practice Address - Street 1:8866 GULF FWY
Practice Address - Street 2:STE 410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-6514
Practice Address - Country:US
Practice Address - Phone:281-842-1338
Practice Address - Fax:281-842-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00385XMedicare ID - Type UnspecifiedGROUP