Provider Demographics
NPI:1659828739
Name:FREEDOM MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:FREEDOM MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-386-9997
Mailing Address - Street 1:8868 S EASTERN AVE
Mailing Address - Street 2:115
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-4823
Mailing Address - Country:US
Mailing Address - Phone:702-386-9997
Mailing Address - Fax:702-228-9996
Practice Address - Street 1:8868 S EASTERN AVE
Practice Address - Street 2:115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4823
Practice Address - Country:US
Practice Address - Phone:702-386-9997
Practice Address - Fax:702-228-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20101789254332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies