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General NPI Number Information
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NPI Number | 1760276646
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Entity Type | Organization
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Legal Business Name | PPM NEVADA LLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 3610 S NEVADA HIGHWAY 160
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City | PAHRUMP
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State | NV
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Zip | 89048-4805
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Country | US
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Telephone | 888-253-6598
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Fax | 801-931-2263
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Provider Business Mailing Address
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Address Line | 1916 N 700 W STE 110
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City | LAYTON
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State | UT
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Zip | 84041-5754
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Country | US
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Telephone | 888-253-6598
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Fax | 801-931-2263
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Authorized Official
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Title or Position | CORPORATE SECRETARY
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Name | AMBER TUELLER
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Credential |
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Telephone | 208-401-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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