Avandy Medical Buttrum PLLC
Organization Active NPI Family Medicine Physician · Henderson, NV
NPI 1043969405 · NPPES record last updated Mar 22, 2022
Key facts
- NPI
- 1043969405
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AVANDY MEDICAL BUTTRUM PLLC
- Practice address
- 660 S Green Valley Pkwy Ste 130
Henderson, NV 89052-0431 - Phone
- (702) 508-2453
- Fax
- (702) 508-2435
- NPI assigned
- Mar 22, 2022
- Organization subpart
- No
Authorized official
- Name
- Mandy Buttrum, MD
- Title
- Owner
- Phone
- (702) 508-2153
Practitioners 5
-
Tina Sajadi, MSN,PMHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220804003379 | NV | Part B Supplier - Clinic/Group Practice | 1456733674 |
Receives reassigned benefits from 5 practitioners Practice locations: Henderson, NV |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
660 S Green Valley Pkwy Ste 130
Henderson, NV 89052-0431
Mailing address
660 S Green Valley Pkwy Ste 130
Henderson, NV 89052-0431
Phone (702) 508-2153
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15199 | Other | NV | PRIMARY CARE |
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All providers in Henderson, NV · Family Medicine Physician in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.