Provider Demographics
NPI:1871185306
Name:ADVANCED MEDICAL OF NORTH TEXAS PLLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL OF NORTH TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-605-9500
Mailing Address - Street 1:5500 N TARRANT PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5392
Mailing Address - Country:US
Mailing Address - Phone:817-605-9500
Mailing Address - Fax:817-605-9503
Practice Address - Street 1:5500 N TARRANT PKWY STE 108
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5392
Practice Address - Country:US
Practice Address - Phone:817-605-9500
Practice Address - Fax:817-605-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty