Healthcare Provider Details

I. General information

NPI: 1295732451
Provider Name (Legal Business Name): ADVANCED HOUSE CALLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S JONES BLVD
LAS VEGAS NV
89107-2614
US

IV. Provider business mailing address

112 S JONES BLVD
LAS VEGAS NV
89107-2614
US

V. Phone/Fax

Practice location:
  • Phone: 702-838-7110
  • Fax: 702-838-7112
Mailing address:
  • Phone: 702-838-7110
  • Fax: 702-838-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7997
License Number StateNV

VIII. Authorized Official

Name: DR. GREGORY K BRYAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 702-838-7110