Provider Demographics
NPI:1386078301
Name:AGELESS MEN'S HEALTH
Entity type:Organization
Organization Name:AGELESS MEN'S HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-757-3643
Mailing Address - Street 1:2560 WIGWAM PKWY
Mailing Address - Street 2:A10
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6226
Mailing Address - Country:US
Mailing Address - Phone:702-243-0028
Mailing Address - Fax:702-252-4315
Practice Address - Street 1:2560 WIGWAM PKWY
Practice Address - Street 2:A10
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6226
Practice Address - Country:US
Practice Address - Phone:702-243-0028
Practice Address - Fax:702-252-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty