Provider Demographics
NPI:1619277274
Name:ROBERT VANCE DO, PC
Entity Type:Organization
Organization Name:ROBERT VANCE DO, PC
Other - Org Name:ADVANCED MEDICAL & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-598-0600
Mailing Address - Street 1:3150 N TENAYA WAY
Mailing Address - Street 2:STE 540
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0443
Mailing Address - Country:US
Mailing Address - Phone:702-256-0121
Mailing Address - Fax:
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:STE 540
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-256-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH52753Medicare UPIN