Provider Demographics
NPI:1760276646
Name:PPM NEVADA LLC
Entity type:Organization
Organization Name:PPM NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:TUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1400
Mailing Address - Street 1:1916 N 700 W STE 110
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5754
Mailing Address - Country:US
Mailing Address - Phone:888-253-6598
Mailing Address - Fax:801-931-2263
Practice Address - Street 1:3610 S NEVADA HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4805
Practice Address - Country:US
Practice Address - Phone:888-253-6598
Practice Address - Fax:801-931-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty