Provider Demographics
NPI:1710765714
Name:PAM SQUARED AT LAS VEGAS, LLC
Entity Type:Organization
Organization Name:PAM SQUARED AT LAS VEGAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MISITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-731-9660
Mailing Address - Street 1:1828 GOOD HOPE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1203
Mailing Address - Country:US
Mailing Address - Phone:717-731-9660
Mailing Address - Fax:
Practice Address - Street 1:930 N. GIBSON RD.
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011
Practice Address - Country:US
Practice Address - Phone:717-731-9660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAM SQUARED AT LAS VEGAS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital