Provider Demographics
NPI:1326423377
Name:ADVANCED MEDICAL PROFESSIONALS LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-800-4652
Mailing Address - Street 1:1151 S BUFFALO DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8313
Mailing Address - Country:US
Mailing Address - Phone:702-800-4652
Mailing Address - Fax:702-960-4008
Practice Address - Street 1:1151 S BUFFALO DR
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8313
Practice Address - Country:US
Practice Address - Phone:702-800-4652
Practice Address - Fax:702-960-4008
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRETUS CONSULTING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12070207Q00000X
NV13914208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty