Provider Demographics
NPI:1861662447
Name:ADVANCED INTERVENTIONS ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ADVANCED INTERVENTIONS ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLIS
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-445-3780
Mailing Address - Street 1:1220 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2865
Mailing Address - Country:US
Mailing Address - Phone:903-445-3780
Mailing Address - Fax:903-759-0891
Practice Address - Street 1:1201 W LOOP 281
Practice Address - Street 2:SUITE 501
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2937
Practice Address - Country:US
Practice Address - Phone:903-445-3780
Practice Address - Fax:903-759-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32316261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D1688Medicare Oscar/Certification