| Advanced Medical Of North Texas Pllc | |
|
5500 N Tarrant Pkwy Ste 108 Fort Worth TX 76244-5392 | |
| (817) 605-9500 | |
| (817) 605-9503 |
| Full Name | Advanced Medical Of North Texas Pllc |
|---|---|
| Speciality | General Practice |
| Location | 5500 N Tarrant Pkwy Ste 108, Fort Worth, Texas |
| Authorized Official Name and Position | Spencer Shanley (OWNER) |
| Authorized Official Contact | 8176059500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Medical Of North Texas Pllc 5500 N Tarrant Pkwy Ste 108 Fort Worth TX 76244-5392 Ph: (817) 605-9500 | Advanced Medical Of North Texas Pllc 5500 N Tarrant Pkwy Ste 108 Fort Worth TX 76244-5392 Ph: (817) 605-9500 |
| NPI Number | 1871185306 |
|---|---|
| Provider Enumeration Date | 02/05/2021 |
| Last Update Date | 02/05/2021 |
| Medicare PECOS PAC ID | 4688080302 |
|---|---|
| Medicare Enrollment ID | O20210304000725 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871185306 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Spencer C Shanley |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1437482031 PECOS PAC ID: 2163687849 Enrollment ID: I20120702000272 |
| Provider Name | Melissa P Holland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215340831 PECOS PAC ID: 9739479791 Enrollment ID: I20160602002080 |
| Provider Name | Sandia Venord |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124783642 PECOS PAC ID: 5496147365 Enrollment ID: I20220126002853 |
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