Provider Demographics
NPI:1497951859
Name:NORTH VALLEY MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:NORTH VALLEY MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-638-1190
Mailing Address - Street 1:3053 W. CRAIG RD #B
Mailing Address - Street 2:
Mailing Address - City:NO LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032
Mailing Address - Country:US
Mailing Address - Phone:702-638-1190
Mailing Address - Fax:702-638-1542
Practice Address - Street 1:3053 W. CRAIG RD #B
Practice Address - Street 2:
Practice Address - City:NO LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-638-1190
Practice Address - Fax:702-638-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV731734754332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507173Medicaid
NV5574360001Medicare NSC