MEDICARE: ADVANCED MEDICINE AND REHABILITATION OF TEXAS, INC.

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1255576369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICINE AND REHABILITATION OF TEXAS, INC.

Provider Business Mailing Address
First Line	:	5510 ABRAMS RD
Second Line	:	112
City	:	DALLAS
State	:	TX
Zip	:	75214-2000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5510 ABRAMS RD
Second Line	:	112
City	:	DALLAS
State	:	TX
Zip	:	75214-2000
Country	:	US
Telephone Number	:	214-363-7000
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	MR. ALI HEIDARPOUR
Credential	:
Telephone Number	:	510-385-6352

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	12/04/2008

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