Provider Demographics
NPI:1134616212
Name:ADVANCED MOBILE MEDICINE LLC
Entity type:Organization
Organization Name:ADVANCED MOBILE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-934-2356
Mailing Address - Street 1:1902 HARLAN DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-6602
Mailing Address - Country:US
Mailing Address - Phone:402-934-3886
Mailing Address - Fax:
Practice Address - Street 1:1902 HARLAN DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-6602
Practice Address - Country:US
Practice Address - Phone:402-934-3886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-15
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111120363LA2200X
363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty