Ageless Nutrition Bar Holdings, Inc
NPI 1932704830ActiveOrganization· Family Medicine, Adult Medicine· Phoenix, AZ
Family Medicine, Adult Medicine in Phoenix, Arizona, registered in NPPES in December 2020. The authorized official on file is Teah Michelle Smith, Credentialing Manager.
Overview
| NPI | 1932704830 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 1, 2020 |
| Last updated in NPPES | Nov 13, 2023 |
| Certified by provider | Nov 13, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine, Adult Medicine Primary | 207QA0505X | — | — |
| Clinic/Center, Primary Care | 261QP2300X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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