Provider Demographics
NPI:1205012812
Name:FLOTSOL INC
Entity Type:Organization
Organization Name:FLOTSOL INC
Other - Org Name:FLOTSOL INC MEDICAL SUPPLIES AND ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUWOLE
Authorized Official - Middle Name:IDOWU
Authorized Official - Last Name:ADEGBORUWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-463-5874
Mailing Address - Street 1:2411 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2123
Mailing Address - Country:US
Mailing Address - Phone:702-463-5874
Mailing Address - Fax:702-405-8084
Practice Address - Street 1:2411 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2123
Practice Address - Country:US
Practice Address - Phone:702-463-5874
Practice Address - Fax:702-405-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2012-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205012812Medicaid
NV6243070001Medicare NSC