Provider Demographics
NPI:1861221418
Name:ADDIS ADVANCED MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:ADDIS ADVANCED MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:725-259-4451
Mailing Address - Street 1:301 N PECOS RD STE E
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 N PECOS RD STE E
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1350
Practice Address - Country:US
Practice Address - Phone:725-200-4391
Practice Address - Fax:833-972-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty