Provider Demographics
NPI:1972782373
Name:ADVANCED BIOMECHANICS, LLC
Entity Type:Organization
Organization Name:ADVANCED BIOMECHANICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:INMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-971-8200
Mailing Address - Street 1:4818 SOUTH JACKSON ROAD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6672
Mailing Address - Country:US
Mailing Address - Phone:956-971-8200
Mailing Address - Fax:956-928-0732
Practice Address - Street 1:4818 SOUTH JACKSON ROAD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6672
Practice Address - Country:US
Practice Address - Phone:956-971-8200
Practice Address - Fax:956-928-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX101224335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170154201Medicaid
TX170154201Medicaid