Provider Demographics
NPI:1679780381
Name:SEQUENT CORPORATION
Entity Type:Organization
Organization Name:SEQUENT CORPORATION
Other - Org Name:FOOT SOLUTIONS OF LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEWITT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:714-222-7095
Mailing Address - Street 1:10520 S EASTERN AVE
Mailing Address - Street 2:#100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3900
Mailing Address - Country:US
Mailing Address - Phone:702-838-8111
Mailing Address - Fax:702-838-8115
Practice Address - Street 1:10520 S EASTERN AVE
Practice Address - Street 2:#100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3900
Practice Address - Country:US
Practice Address - Phone:702-838-8111
Practice Address - Fax:702-838-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMP00225332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4893300001Medicare NSC
NV4893300001Medicare ID - Type UnspecifiedDIABETIC FOOTWEAR & ORTHO