Provider Demographics
NPI:1639246077
Name:ANG MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:ANG MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DADYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-795-0126
Mailing Address - Street 1:6332 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3035
Mailing Address - Country:US
Mailing Address - Phone:702-795-0126
Mailing Address - Fax:702-795-0976
Practice Address - Street 1:6332 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3035
Practice Address - Country:US
Practice Address - Phone:702-795-0126
Practice Address - Fax:702-795-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMP00330332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5619930001Medicare PIN