MEDICARE: VANCE FAMILY LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	057102	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	057102	OTHER	TX	TDH LICENSE
2	AMB640	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1053314294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANCE FAMILY LLP

Provider Business Mailing Address
First Line	:	920 BLUEBONNET DR
Second Line	:	STE 101
City	:	IRVING
State	:	TX
Zip	:	75060-4501
Country	:	US
Telephone Number	:	972-554-9300
Fax Number	:	972-554-9302

Provider Business Practice Location Address
First Line	:	920 BLUEBONNET DR
Second Line	:	STE 101
City	:	IRVING
State	:	TX
Zip	:	75060-4501
Country	:	US
Telephone Number	:	972-554-9300
Fax Number	:	972-554-9302

Authorized Official
Title or Position	:	BUSINESS DEVELOPER
Name	:	JENNIFER THOMAS
Credential	:
Telephone Number	:	972-554-9300

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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Directions to “VANCE FAMILY LLP ” Practice Location

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