Provider Demographics
NPI:1710496245
Name:ADVANCED HEALTH & DIAGNOSTIC PARTNERS
Entity Type:Organization
Organization Name:ADVANCED HEALTH & DIAGNOSTIC PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIRT
Authorized Official - Middle Name:
Authorized Official - Last Name:REPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-831-6290
Mailing Address - Street 1:6700 WOODLANDS PKWY STE 230-210
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2575
Mailing Address - Country:US
Mailing Address - Phone:281-831-6290
Mailing Address - Fax:832-442-3800
Practice Address - Street 1:95 S FAIR MANOR CIR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1085
Practice Address - Country:US
Practice Address - Phone:281-831-6290
Practice Address - Fax:832-442-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1962428656OtherPHYSICAL MEDICINE AND REHABILITATION