Healthcare Provider Details

I. General information

NPI: 1417520313
Provider Name (Legal Business Name): TBI3 NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHADOW LN
LAS VEGAS NV
89106-4363
US

IV. Provider business mailing address

2835 W PEBBLE RD UNIT 503
LAS VEGAS NV
89123-6499
US

V. Phone/Fax

Practice location:
  • Phone: 702-340-0562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA RUTLEDGE
Title or Position: COO
Credential:
Phone: 936-648-5161