Provider Demographics
NPI:1154593283
Name:ADVANCED MEDICINE & REHABILITATION OF TEXAS
Entity type:Organization
Organization Name:ADVANCED MEDICINE & REHABILITATION OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDARPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-696-2273
Mailing Address - Street 1:PO BOX 31223
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0021
Mailing Address - Country:US
Mailing Address - Phone:214-696-2273
Mailing Address - Fax:
Practice Address - Street 1:5510 ABRAMS RD # 112
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2000
Practice Address - Country:US
Practice Address - Phone:214-696-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8719207R00000X
TXG4220207X00000X
TXD1711208VP0000X
TX100390225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty