Healthcare Provider Details

I. General information

NPI: 1063688380
Provider Name (Legal Business Name): NEW ADVANCED MEDICAL DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9896 BISSONNET ST STE 230
HOUSTON TX
77036-8152
US

IV. Provider business mailing address

9896 BISSONNET ST STE 230
HOUSTON TX
77036-8152
US

V. Phone/Fax

Practice location:
  • Phone: 713-981-4946
  • Fax: 713-981-4925
Mailing address:
  • Phone: 713-981-4946
  • Fax: 713-981-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2278G1100X
TaxonomyGeneral Care Certified Respiratory Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. PHYLLIS A CARTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 713-981-4946