Provider Demographics
NPI:1497360648
Name:ADVANCED MOLECULAR PET IMAGING LLC
Entity Type:Organization
Organization Name:ADVANCED MOLECULAR PET IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-817-0375
Mailing Address - Street 1:1771 E FLAMINGO RD STE 121A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0837
Mailing Address - Country:US
Mailing Address - Phone:702-817-0375
Mailing Address - Fax:702-901-7414
Practice Address - Street 1:801 S RANCHO DR STE A2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3870
Practice Address - Country:US
Practice Address - Phone:702-817-0375
Practice Address - Fax:702-901-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty