MEDICARE: ADVANCED NEUROLOGICAL SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	225XP0200X	Pediatric Occupational Therapist	TX
2	235Z00000X	Speech-Language Pathologist
3	2251P0200X	Pediatric Physical Therapist	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	38332	OTHER	BEECHSTREET HMO
2	NTX11	OTHER	NTHN
3	61101	OTHER	HUMANA
4	62308	OTHER	CIGNA
5	74223	OTHER	BENEFIT PLANNERS-PHCS HMO
6	87726	OTHER	UNITED HEALTHCARE
7	39141	OTHER	FIRST HEALTH PPO
8	87043	OTHER	FIRST HEALTH HMO
9	95959	OTHER	PACIFICARE HMO
10	48143	OTHER	GROUP AND PENSION
11	80705	OTHER	ONE HEALTH PLAN
12	84146	OTHER	CHAMP VA
13	87265	OTHER	BENESIGHT-UHC HMO
14	80314	OTHER	UNICARE
15	44054	OTHER	GEHA-PHCS HMO
16	37283	OTHER	GALLAGHER BENEFIT ADMIN
17	62413	OTHER	MAIL HANDLERS BENEFIT PLA
18	67466	OTHER	PACIFIC LIFE & ANNUITY

General Provider Information

NPI Number	:	1811917206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED NEUROLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	2755 ALTAMESA BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5803
Country	:	US
Telephone Number	:	817-292-2208
Fax Number	:	817-292-0572

Provider Business Practice Location Address
First Line	:	2755 ALTAMESA BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5803
Country	:	US
Telephone Number	:	817-292-2208
Fax Number	:	817-292-0572

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOANIE C POWELL
Credential	:	OT
Telephone Number	:	817-292-2208

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	09/11/2025

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