Healthcare Provider Details

I. General information

NPI: 1386923597
Provider Name (Legal Business Name): AGELESS MEN'S HEALTH HOLDINGS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13435 N US HIGHWAY 183 SUITE 302
AUSTIN TX
78750-3218
US

IV. Provider business mailing address

13435 N US HIGHWAY 183 SUITE 302
AUSTIN TX
78750-3218
US

V. Phone/Fax

Practice location:
  • Phone: 901-522-6745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WILKINSON
Title or Position: BUSINESS OPERATIONS DIRECTOR
Credential:
Phone: 702-818-0446