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Organization
AGELESS MEN'S HEALTH SERIES II NE LLC
Active
Organization
AGELESS MEN'S HEALTH SERIES II NE LLC
Active
Other names
Ageless Men's Health
Organization subpart
No
Provider details
NPI number
Authorized official
TEAH MICHELLE SMITH (CREDENTIALING MANAGER)
(901) 205-3999
Entity
Organization
Contact information
Practice address
5715 S 34TH ST STE 400, LINCOLN, NE 68516-6648
(901) 757-3643
Mailing address
5715 S 34TH ST STE 400, LINCOLN, NE 68516-6648
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
NULL
Other
Enumeration date
05/06/2020
Last updated
11/21/2023
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