Healthcare Provider Details

I. General information

NPI: 1578180469
Provider Name (Legal Business Name): ATHLETE ADVANTAGE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 S RAINBOW BLVD STE 100
LAS VEGAS NV
89118-3217
US

IV. Provider business mailing address

6771 W CHARLESTON BLVD STE B
LAS VEGAS NV
89146-9016
US

V. Phone/Fax

Practice location:
  • Phone: 800-674-9515
  • Fax: 702-988-5154
Mailing address:
  • Phone: 800-674-9515
  • Fax: 702-508-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES MURPHY
Title or Position: OWNER
Credential: CEO
Phone: 702-485-5493