Healthcare Provider Details

I. General information

NPI: 1922287804
Provider Name (Legal Business Name): ADVANT-EDGE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14476 HORIZON BLVD STE J
HORIZON CITY TX
79928-8578
US

IV. Provider business mailing address

14476 HORIZON BLVD STE J
HORIZON CITY TX
79928-8578
US

V. Phone/Fax

Practice location:
  • Phone: 915-852-8884
  • Fax: 915-852-1727
Mailing address:
  • Phone: 915-852-8884
  • Fax: 915-852-1727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number25772
License Number StateTX

VIII. Authorized Official

Name: EUSTACIO RIVAS
Title or Position: PRESIDENT
Credential:
Phone: 915-309-9343