MEDICARE: ATHLETE ADVANTAGE MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207P00000X	Emergency Medicine Physician
2	207RS0010X	Sports Medicine (Internal Medicine) Physician
3	2084N0400X	Neurology Physician
4	225100000X	Physical Therapist
5	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578180469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETE ADVANTAGE MEDICAL LLC

Provider Business Mailing Address
First Line	:	6771 W CHARLESTON BLVD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9016
Country	:	US
Telephone Number	:	800-674-9515
Fax Number	:	702-508-2435

Provider Business Practice Location Address
First Line	:	6315 S RAINBOW BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3217
Country	:	US
Telephone Number	:	800-674-9515
Fax Number	:	702-988-5154

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES MURPHY
Credential	:	CEO
Telephone Number	:	702-485-5493

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	10/24/2022

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Directions to “ATHLETE ADVANTAGE MEDICAL LLC ” Practice Location

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