MEDICARE: ADVANCED MEDICAL MANAGEMENT, LLC

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	261QR0200X	Radiology Clinic/Center	R28006	TX

General Provider Information

NPI Number	:	1285765644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	2386 S DAIRY ASHFORD ST # 575
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-5739
Country	:	US
Telephone Number	:	281-920-4515
Fax Number	:	281-754-4957

Provider Business Practice Location Address
First Line	:	2386 S DAIRY ASHFORD ST # 575
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-5739
Country	:	US
Telephone Number	:	281-920-4515
Fax Number	:	281-754-4957

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MELISSA GARCIA
Credential	:
Telephone Number	:	281-920-4515

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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