Provider Demographics
NPI:1366597486
Name:ADVANCED MEDICAL CENTER
Entity type:Organization
Organization Name:ADVANCED MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEJMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BADY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-727-5500
Mailing Address - Street 1:PO BOX 6380
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89041-6380
Mailing Address - Country:US
Mailing Address - Phone:775-727-5500
Mailing Address - Fax:775-727-5689
Practice Address - Street 1:1501 E CALVADA BLVD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-0000
Practice Address - Country:US
Practice Address - Phone:775-727-5509
Practice Address - Fax:775-727-5689
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-25
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10841207LP2900X
NV828207Q00000X, 207R00000X
NV11604207R00000X
NV12152208000000X
NV13252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100512049Medicaid
NV100512049Medicaid
NVV34236Medicare ID - Type UnspecifiedGROUP LEGACY NO