Provider Demographics
NPI:1710384854
Name:MEDICAL SUPPLIES LAS VEGAS INC
Entity Type:Organization
Organization Name:MEDICAL SUPPLIES LAS VEGAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ARINOLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADEGBORUWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-688-0690
Mailing Address - Street 1:2810 W CHARLESTON BLVD
Mailing Address - Street 2:STE H83
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1921
Mailing Address - Country:US
Mailing Address - Phone:702-688-0690
Mailing Address - Fax:
Practice Address - Street 1:2810 W CHARLESTON BLVD
Practice Address - Street 2:STE H83
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1921
Practice Address - Country:US
Practice Address - Phone:702-688-0690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment