MEDICARE: ADVANCED NEUROLOGICAL SERVICES

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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0086GB	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1386647634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED NEUROLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	2755 ALTA MESA BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5803
Country	:	US
Telephone Number	:	817-292-2208
Fax Number	:	817-292-8021

Provider Business Practice Location Address
First Line	:	2755 ALTA MESA BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5803
Country	:	US
Telephone Number	:	817-292-2208
Fax Number	:	817-292-8021

Authorized Official
Title or Position	:	DRO
Name	:	MRS. BELINDA MCBAIN
Credential	:
Telephone Number	:	817-292-2208

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/22/2020

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Directions to “ADVANCED NEUROLOGICAL SERVICES ” Practice Location

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