Provider Demographics
NPI:1013579739
Name:NICKES MEDICAL SUPPLY, LLC.
Entity Type:Organization
Organization Name:NICKES MEDICAL SUPPLY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:AUSTIN-ELEJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-533-8870
Mailing Address - Street 1:2820 N STANTON ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2509
Mailing Address - Country:US
Mailing Address - Phone:915-533-8870
Mailing Address - Fax:915-533-0078
Practice Address - Street 1:5405 E GRANITE ST BLDG 2527
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707-3004
Practice Address - Country:US
Practice Address - Phone:520-745-4681
Practice Address - Fax:520-745-4548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies