Provider Demographics
NPI:1700819786
Name:NORTHERN NEVADA MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:NORTHERN NEVADA MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:CATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-824-9911
Mailing Address - Street 1:1395 GREG ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6073
Mailing Address - Country:US
Mailing Address - Phone:775-824-9911
Mailing Address - Fax:775-824-9910
Practice Address - Street 1:1395 GREG ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6073
Practice Address - Country:US
Practice Address - Phone:775-824-9911
Practice Address - Fax:775-824-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMP00387332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510205Medicaid
5720560001Medicare NSC