Provider Demographics
NPI:1356763916
Name:FREEDOM FAMILY MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:FREEDOM FAMILY MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:702-293-5945
Mailing Address - Street 1:555 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2757
Mailing Address - Country:US
Mailing Address - Phone:702-293-5945
Mailing Address - Fax:702-293-5168
Practice Address - Street 1:555 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2757
Practice Address - Country:US
Practice Address - Phone:702-293-5945
Practice Address - Fax:702-293-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty