Provider Demographics
NPI:1407333081
Name:MEDALLION HEALTH LLC
Entity Type:Organization
Organization Name:MEDALLION HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-240-3686
Mailing Address - Street 1:400 S 4TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-6207
Mailing Address - Country:US
Mailing Address - Phone:888-240-3686
Mailing Address - Fax:
Practice Address - Street 1:400 S 4TH ST STE 500
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6207
Practice Address - Country:US
Practice Address - Phone:888-240-3686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies