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General NPI Number Information
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NPI Number | 1124366232
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Entity Type | Organization
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Legal Business Name | ADVANCED NEURO SOLUTIONS, LLC
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 4516 LOVERS LN STE. 331
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City | DALLAS
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State | TX
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Zip | 75225-6925
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Country | US
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Telephone | 214-675-0905
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Fax | 214-317-4888
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Provider Business Mailing Address
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Address Line | PO BOX 649209
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City | DALLAS
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State | TX
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Zip | 75264-9209
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Country | US
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Telephone | 214-675-0905
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Fax | 214-317-4888
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TRASE MAHAN
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Credential |
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Telephone | 214-675-0905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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