A-Grav 1 LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

A-GRAV 1 LLC

Practice address

365 E Windmill LN
Las Vegas, NV 89123-1807

Phone

(702) 675-3569

Fax

(702) 701-9413

NPI assigned

Mar 29, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Dennis Lavern Dubois

Title

Managing Member

Phone

(702) 373-8151

Specialties & licenses 2

Addresses

Other names 1

• MOON WALK CARDIO Doing business as

Locations

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

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364515200000",
    "number": "1982947701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2375 E TROPICANA AVE # 271",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196564",
            "telephone_number": "702-675-3569",
            "fax_number": "702-701-9413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 E WINDMILL LN",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891231807",
            "telephone_number": "702-675-3569",
            "fax_number": "702-701-9413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A-GRAV 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-29",
        "last_updated": "2013-03-29",
        "status": "A",
        "authorized_official_last_name": "DUBOIS",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "LAVERN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "702-373-8151",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOON WALK CARDIO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health Service Clinic/Center in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Health Service Clinic/Center in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; 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.