Healthcare Provider Details

I. General information

NPI: 1154924785
Provider Name (Legal Business Name): AMH SERIES II NV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 SIERRA ROSE DR. SUITE A1
RENO NV
89511
US

IV. Provider business mailing address

630 SIERRA ROSE DR. SUITE A1
RENO NV
89511
US

V. Phone/Fax

Practice location:
  • Phone: 901-757-3643
  • Fax:
Mailing address:
  • Phone: 901-757-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TEAH MICHELLE SMITH
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 901-205-3999