MEDICARE: ADVANTAGE INFUSION SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336H0001X	Home Infusion Therapy Pharmacy	16174	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598826018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE INFUSION SERVICES, INC.

Provider Business Mailing Address
First Line	:	8080 TRISTAR DRIVE
Second Line	:	SUITE 120
City	:	IRVING
State	:	TX
Zip	:	75063-2823
Country	:	US
Telephone Number	:	972-815-0461
Fax Number	:	877-302-5251

Provider Business Practice Location Address
First Line	:	6019 RANDOLPH BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-5719
Country	:	US
Telephone Number	:	210-599-7276
Fax Number	:	210-599-8621

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES D GLYNN
Credential	:
Telephone Number	:	949-273-6528

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	06/21/2013

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