Healthcare Provider Details

I. General information

NPI: 1326423377
Provider Name (Legal Business Name): ADVANCED MEDICAL PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 S BUFFALO DR SUITE 130
LAS VEGAS NV
89117-8313
US

IV. Provider business mailing address

1151 S BUFFALO DR SUITE 130
LAS VEGAS NV
89117-8313
US

V. Phone/Fax

Practice location:
  • Phone: 702-800-4652
  • Fax: 702-960-4008
Mailing address:
  • Phone: 702-800-4652
  • Fax: 702-960-4008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12070
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number13914
License Number StateNV

VIII. Authorized Official

Name: COLLIN PROSSER
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-800-4652