Ageless Men'S Health, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

AGELESS MEN'S HEALTH, PLLC

Practice address

4970 W Highway 290
Suite 470
Austin, TX 78735-6748

Phone

(512) 892-1900

Fax

(512) 892-1904

NPI assigned

Oct 26, 2012

Organization subpart

Yes

Parent organization

AGELESS MEN'S HEALTH HOLDINGS, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Melissa C McClellan

Title

VP of Operations

Phone

(901) 757-3643

Specialties & licenses 1

Addresses

Tax ID family

Ageless Men'S Health PLLC3 organizations share this tax ID, including this one

Part of

Ageless Men'S Health

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Ageless Men'S Health PLLC

  • Specialist
  • Austin, TX
  • NPI 1235482316
  NPD tax ID
• Ageless Men'S Health, PLLC

  • Specialist
  • Houston, TX
  • NPI 1790038875
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351209600000",
    "number": "1063765147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4970 W HIGHWAY 290",
            "address_2": "SUITE 470",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787356748",
            "telephone_number": "512-892-1900",
            "fax_number": "512-892-1904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4970 W HIGHWAY 290",
            "address_2": "SUITE 470",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787356748",
            "telephone_number": "512-892-1900",
            "fax_number": "512-892-1904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGELESS MEN'S HEALTH, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AGELESS MEN'S HEALTH HOLDINGS, LLC",
        "enumeration_date": "2012-10-26",
        "last_updated": "2012-10-26",
        "status": "A",
        "authorized_official_last_name": "MCCLELLAN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "901-757-3643",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Austin, TX
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.