Provider Demographics
NPI:1720042369
Name:BRADLEY G. MAURER
Entity Type:Organization
Organization Name:BRADLEY G. MAURER
Other - Org Name:FREEDOM MEDICAL SUPPLY & EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-386-9997
Mailing Address - Street 1:2470 E. PEBBLE RD
Mailing Address - Street 2:#115
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7092
Mailing Address - Country:US
Mailing Address - Phone:702-386-9997
Mailing Address - Fax:702-228-9996
Practice Address - Street 1:2470 E. PEBBLE RD
Practice Address - Street 2:#115
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7092
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:2006-04-12
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV635527296332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504117Medicaid
NV100504117Medicaid