Provider Demographics
NPI:1689752081
Name:ISU INC.
Entity Type:Organization
Organization Name:ISU INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKA
Authorized Official - Middle Name:HUMPHREY
Authorized Official - Last Name:EJIOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-459-7500
Mailing Address - Street 1:1745 N NELLIS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3673
Mailing Address - Country:US
Mailing Address - Phone:702-459-7500
Mailing Address - Fax:702-459-1176
Practice Address - Street 1:1745 N NELLIS BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-3673
Practice Address - Country:US
Practice Address - Phone:702-459-7500
Practice Address - Fax:702-459-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMP00286332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506054Medicaid
NV5407420001OtherDMEPOS
NV5407420001Medicare NSC