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General NPI Number Information
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NPI Number | 1235595737
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Entity Type | Organization
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Legal Business Name | BIOADVANCE PROSTHETIC SOLUTIONS, PLLC
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 1111 RAINTREE CIR SUITE 150
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City | ALLEN
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State | TX
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Zip | 75013-4901
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Country | US
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Telephone | 972-521-6101
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Fax | 972-521-6102
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Provider Business Mailing Address
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Address Line | 1111 RAINTREE CIR SUITE 150
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City | ALLEN
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State | TX
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Zip | 75013-4901
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Country | US
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Telephone | 972-521-6101
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Fax | 972-521-6102
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Authorized Official
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Title or Position | PROSTHETIST
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Name | MR. SCOTT WAYNE WILLIAMS
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Credential | C.P.O., L.P
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Telephone | 972-521-6101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | 1525
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 1525
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License Number State | TX
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