Provider Demographics
NPI:1083821813
Name:UNILIFE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:UNILIFE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:O
Authorized Official - Last Name:UTOMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-897-7070
Mailing Address - Street 1:3950 E SUNSET RD STE 116
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4906
Mailing Address - Country:US
Mailing Address - Phone:702-897-7070
Mailing Address - Fax:702-647-1142
Practice Address - Street 1:3950 E SUNSET RD STE 116
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4906
Practice Address - Country:US
Practice Address - Phone:702-897-7070
Practice Address - Fax:702-647-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000015424332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4559630001Medicare NSC