MEDICARE: PROLISTIC HEALTH 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	261QP2300X	Primary Care Clinic/Center
2	207QS0010X	Sports Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1881582401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROLISTIC HEALTH LLC

Provider Business Mailing Address
First Line	:	6315 S RAINBOW BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3217
Country	:	US
Telephone Number	:	702-351-3730
Fax Number	:

Provider Business Practice Location Address
First Line	:	6315 S RAINBOW BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3217
Country	:	US
Telephone Number	:	702-351-3730
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. STANTON JAMES MURPHY
Credential	:
Telephone Number	:	702-351-3730

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/24/2025

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Directions to “PROLISTIC HEALTH LLC ” Practice Location

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