Provider Demographics
NPI:1407025026
Name:LV MEDICAL SUPPLY SERVICE INC
Entity Type:Organization
Organization Name:LV MEDICAL SUPPLY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELDERRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-279-2008
Mailing Address - Street 1:3201 N 16TH ST
Mailing Address - Street 2:STE 12
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7160
Mailing Address - Country:US
Mailing Address - Phone:602-279-2008
Mailing Address - Fax:480-445-9790
Practice Address - Street 1:3201 N 16TH ST
Practice Address - Street 2:STE 12
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7160
Practice Address - Country:US
Practice Address - Phone:602-279-2008
Practice Address - Fax:602-445-9125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies