Provider Demographics
NPI:1932338258
Name:ADVANCED EAR NOSE & THROAT-HEAD AND NECK SURGERY LLC
Entity Type:Organization
Organization Name:ADVANCED EAR NOSE & THROAT-HEAD AND NECK SURGERY LLC
Other - Org Name:ADVANCED EAR NOSE & THROAT - HEAD AND NECK SURGEON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-834-5886
Mailing Address - Street 1:6955 N DURANGO DR STE 1115-363
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4411
Mailing Address - Country:US
Mailing Address - Phone:702-834-5886
Mailing Address - Fax:702-834-5752
Practice Address - Street 1:6850 N DURANGO DR
Practice Address - Street 2:SUITE 314
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4595
Practice Address - Country:US
Practice Address - Phone:702-834-5886
Practice Address - Fax:702-834-5752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207YX0007X
NVDO1487207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty