Provider Demographics
NPI:1811917206
Name:ADVANCED NEUROLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:ADVANCED NEUROLOGICAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:817-292-2208
Mailing Address - Street 1:2755 ALTAMESA BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5803
Mailing Address - Country:US
Mailing Address - Phone:817-292-2208
Mailing Address - Fax:817-292-0572
Practice Address - Street 1:2755 ALTAMESA BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5803
Practice Address - Country:US
Practice Address - Phone:817-292-2208
Practice Address - Fax:817-292-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225XP0200X, 2251P0200X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
38332OtherBEECHSTREET HMO
NTX11OtherNTHN
61101OtherHUMANA
62308OtherCIGNA
74223OtherBENEFIT PLANNERS-PHCS HMO
87726OtherUNITED HEALTHCARE
39141OtherFIRST HEALTH PPO
87043OtherFIRST HEALTH HMO
95959OtherPACIFICARE HMO
48143OtherGROUP AND PENSION
80705OtherONE HEALTH PLAN
84146OtherCHAMP VA
87265OtherBENESIGHT-UHC HMO
80314OtherUNICARE
44054OtherGEHA-PHCS HMO
37283OtherGALLAGHER BENEFIT ADMIN
62413OtherMAIL HANDLERS BENEFIT PLA
67466OtherPACIFIC LIFE & ANNUITY
80705OtherONE HEALTH PLAN