Healthcare Provider Details

I. General information

NPI: 1316501638
Provider Name (Legal Business Name): ADVANTA HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 MAPLESHADE LN
PLANO TX
75093-0012
US

IV. Provider business mailing address

5101 ROSS AVE
DALLAS TX
75206-7762
US

V. Phone/Fax

Practice location:
  • Phone: 346-267-7214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANIL VIRANI
Title or Position: MANAGING PARTNER
Credential:
Phone: 346-267-7214