Organization
ADVANCED LIFESTYLE SOLUTIONS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RITA PANNELL (REVENUE CYCLE MGR)
(214) 310-6763
Entity
Organization
Contact information
Practice address
9560 LEGACY DR STE 260, FRISCO, TX 75033-6753
(469) 486-3811
Mailing address
1162 HONEY CRK, NEW BRAUNFELS, TX 78132-3453
(214) 310-6763
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200844440A
—
OK
Enumeration date
08/05/2020
Last updated
08/05/2020
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