MEDICARE: ADVANCED MOLECULAR PET IMAGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1497360648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MOLECULAR PET IMAGING LLC

Provider Business Mailing Address
First Line	:	4200 W RUSSELL RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2365
Country	:	US
Telephone Number	:	725-258-6793
Fax Number	:	725-258-6794

Provider Business Practice Location Address
First Line	:	5785 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5659
Country	:	US
Telephone Number	:	725-258-6793
Fax Number	:	725-258-6794

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JAMES BALLOW
Credential	:
Telephone Number	:	725-258-6793

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	09/23/2025

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