Provider Demographics
NPI:1902422181
Name:ASPIRE MD PLLC
Entity Type:Organization
Organization Name:ASPIRE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROOMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-800-5886
Mailing Address - Street 1:653 N TOWN CENTER DR STE 204
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0516
Mailing Address - Country:US
Mailing Address - Phone:702-800-5886
Mailing Address - Fax:866-340-7475
Practice Address - Street 1:1930 VILLAGE CENTER CIR # 3-389
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6299
Practice Address - Country:US
Practice Address - Phone:702-800-5886
Practice Address - Fax:866-340-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care