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General NPI Number Information
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NPI Number | 1093092322
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Entity Type | Organization
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Legal Business Name | ADVANTAGE DIAGNOSTICS LLC
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 9337 SPRING CYPRESS RD STE E4
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City | SPRING
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State | TX
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Zip | 77379-3484
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Country | US
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Telephone | 281-773-2018
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 112
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City | BARKER
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State | TX
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Zip | 77413-0112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ETHAN SANDERS
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Credential |
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Telephone | 281-773-2018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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