Healthcare Provider Details

I. General information

NPI: 1669449930
Provider Name (Legal Business Name): AMERICAN ANCILLARIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4135 N RANCHO DR STE 110
LAS VEGAS NV
89130-3494
US

IV. Provider business mailing address

555 E NORTH LN STE 5075
CONSHOHOCKEN PA
19428-2490
US

V. Phone/Fax

Practice location:
  • Phone: 702-368-4477
  • Fax: 702-368-3543
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number412243425
License Number StateNV

VIII. Authorized Official

Name: WENDY RUSSALESI
Title or Position: CCO
Credential:
Phone: 484-246-9499