Provider Demographics
NPI:1457091464
Name:ALTERNATIVE HEALTH, PROF L.L.C
Entity Type:Organization
Organization Name:ALTERNATIVE HEALTH, PROF L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:PROTHRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-384-3170
Mailing Address - Street 1:PO BOX 11248
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89510-1248
Mailing Address - Country:US
Mailing Address - Phone:775-384-3170
Mailing Address - Fax:
Practice Address - Street 1:1465 TERMINAL WAY STE 5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3200
Practice Address - Country:US
Practice Address - Phone:775-384-3170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty