Provider Demographics
NPI:1326360686
Name:AGELESS MEN'S HEALTH NV, LLC
Entity Type:Organization
Organization Name:AGELESS MEN'S HEALTH NV, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-252-8378
Mailing Address - Street 1:2821 W HORIZON RIDGE PKWY
Mailing Address - Street 2:111
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4427
Mailing Address - Country:US
Mailing Address - Phone:702-252-8378
Mailing Address - Fax:702-242-0098
Practice Address - Street 1:2821 W HORIZON RIDGE PKWY
Practice Address - Street 2:111
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4427
Practice Address - Country:US
Practice Address - Phone:702-252-8378
Practice Address - Fax:702-242-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4498208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty