Provider Demographics
NPI:1972007169
Name:ADVANCED ISOTOPES OF NEVADA, LLC
Entity Type:Organization
Organization Name:ADVANCED ISOTOPES OF NEVADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO - PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SPATAFORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-208-6418
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:702-476-8600
Mailing Address - Fax:702-750-1376
Practice Address - Street 1:1771 E FLAMINGO RD STE 121A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0837
Practice Address - Country:US
Practice Address - Phone:702-476-8600
Practice Address - Fax:702-750-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPHNU024533336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy