PROSTHETICS ADVANCEMENT LAB, LLC (NPI# 1659851699) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659851699 |
| Entity Type | Organization |
| Organization Name | PROSTHETICS ADVANCEMENT LAB, LLC |
| Practice Address |
3199 E Warm Springs Rd Ste 300 Las Vegas NV 89120-3150 |
| Practice Telephone | 7022079500 |
| Practice Fax Number | 7028520492 |
| Mailing Telephone | 7022079500 |
| Mailing Fax Number | 7028520492 |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2020-07-02 |
| Authorized Official Name | JANET C CHAO (MANAGING MEMBER) |
| Authorized Official Telephone | 7026099203 |
| Authorized Official Credential | BCO, CCA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 156FX1700X |
Technician/Technologist Specialization: Ocularist |
Eye and Vision Services Providers | ||
| Y | 229N00000X | Anaplastologist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | 1972002632 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972002632 | Prosthetics Advancement Lab, LLC | Anaplastologist | 3199 E Warm Springs Rd Ste 300, Las Vegas, NV 89120-3150 | 2018-02-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PROSTHETICS ADVANCEMENT LAB, LLC | 3199 E Warm Springs Rd Ste 300, Las Vegas, NV 89120-3150 |
| Street Address |
3199 E WARM SPRINGS RD STE 300 |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89120-3150 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285081331 | Janet C Chao | Technician/Technologist | 3199 E Warm Springs Rd Ste 300, Las Vegas, NV 89120-3150 | 2016-05-18 |
| 1972002632 | Prosthetics Advancement Lab, LLC | Anaplastologist | 3199 E Warm Springs Rd Ste 300, Las Vegas, NV 89120-3150 | 2018-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447850144 | Mental Edge Therapy Professional LLC | Psychologist | 2520 St. Rose Parkway, Suite 220-a (219), Las Vegas, NV 89120 | 2020-10-30 |
| 1740896877 | Global Behavior Analyst | Behavioral Analyst | 2510 East Sunset Rd, Ste 5 Pmb 670, Las Vegas, NV 89120 | 2020-09-23 |
| 1225656804 | Michael Y Chang Md PC | Anesthesiology | 2700 Sunset Rd B18, Las Vegas, NV 89120 | 2020-07-09 |
| 1053962142 | Arlene M Mcmillen | Technician | 3321 Casey Drive, Apt 104 Bldg 15, Las Vegas, NV 89120 | 2019-09-20 |
| 1942858634 | Michael A Fortunato Md Pllc | Anesthesiology | Michael A Fortunato, Md Pllc, 2700 Sunset Rd #b18, Las Vegas, NV 89120 | 2019-08-27 |
| 1023664521 | Christine White | Behavior Technician | 8431 Sunset Road, Suite 110, Henderson, NV 89120 | 2019-08-12 |
| 1922653435 | David Stefon Mayo | Technician | 3960 E. Patrick Lane, Suite 202., Las Vegas, NV 89120 | 2019-08-02 |
| 1346893724 | Joseph Acuna | Technician | 3960 E. Patrick Lane, Suite 202, Las Vegas, NV 89120 | 2019-07-24 |
| 1588217582 | Va Natasha Manutai | Technician | 3980 E Patrick Lane, Suite 202, Las Vegas, NV 89120 | 2019-07-18 |
| 1811557788 | Fidencia Gutierrez | Chore Provider | 2690 Chandler Ave. Ste. 1, Ste. 1, Las Vegas, NV 89120 | 2019-06-13 |
| Find all providers in zip 89120 | ||||
| Taxonomy Code | 229N00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Anaplastologist |
| An anaplastologist is a professional who creates prostheses for the face and body. Patients treated include those missing anatomy due to cancer, traumatic injury, or birth differences. Generally, there are no state licensing requirements for anaplastologists. Certification specific to anaplastology is provided through the Board for Certified Clinical Anaplastology (BCCA) with a credential title of Certified Clinical Anaplastologist (CCA). |
| Notes: Source: American Anaplastology Association, www.anaplastology.org. [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972002632 | Prosthetics Advancement Lab, LLC | Anaplastologist | 3199 E Warm Springs Rd Ste 300, Las Vegas, NV 89120-3150 | 2018-02-08 |
| 1457893547 | Billy Lee Earl | Anaplastologist | 2525 N Decatur Blvd Ste 2&3, Las Vegas, NV 89108-2975 | 2016-11-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.