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General NPI Number Information
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NPI Number | 1407151541
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Entity Type | Organization
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Legal Business Name | ADVANCED MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 1381 LAKE PARK WAY
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City | RICHARDSON
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State | TX
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Zip | 75080
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Country | US
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Telephone | 214-356-8716
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Fax |
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Provider Business Mailing Address
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Address Line | 811 FARMERS MARKET WAY
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City | DALLAS
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State | TX
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Zip | 75201-8473
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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 | MR. FURQAN KHAN
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Credential |
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Telephone | 469-834-0722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | M5617
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License Number State | TX
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