1326423377 NPI number — ADVANCED MEDICAL PROFESSIONALS LLC

Table of content: (NPI 1326423377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326423377 NPI number — ADVANCED MEDICAL PROFESSIONALS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MEDICAL PROFESSIONALS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326423377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1151 S BUFFALO DR
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-8313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-800-4652
Provider Business Mailing Address Fax Number:
702-960-4008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1151 S BUFFALO DR
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89117-8313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-800-4652
Provider Business Practice Location Address Fax Number:
702-960-4008
Provider Enumeration Date:
07/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PROSSER
Authorized Official First Name:
COLLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
702-800-4652

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  12070 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0014X , with the licence number: 13914 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com