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Organization
A MEDICAL ADVANTAGE HEALTHCARE SYSTEMS ASSOCIATED
Active
Organization
A MEDICAL ADVANTAGE HEALTHCARE SYSTEMS ASSOCIATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA L RILEY (ADMINISTRATOR)
(214) 943-9431
Entity
Organization
Contact information
Practice address
214 W COLORADO BLVD, DALLAS, TX 75208-2326
(214) 943-9431
(214) 943-9407
Mailing address
PO BOX 3770, DALLAS, TX 75208-1070
(214) 943-9431
(214) 943-9407
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0055GM
BCBS
TX
05
—
149612703
—
TX
Enumeration date
05/17/2006
Last updated
09/28/2009
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