Provider Demographics
NPI:1467923789
Name:AMADOR MEDICAL, LLC
Entity Type:Organization
Organization Name:AMADOR MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-724-1734
Mailing Address - Street 1:4325 DEAN MARTIN DR STE 340
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4168
Mailing Address - Country:US
Mailing Address - Phone:702-724-1734
Mailing Address - Fax:702-834-8490
Practice Address - Street 1:963 S ORCHARD ST STE 203
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1962
Practice Address - Country:US
Practice Address - Phone:208-514-0173
Practice Address - Fax:208-514-2293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMADOR MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-14
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies