Provider Demographics
NPI:1750452306
Name:ADL MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:ADL MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-358-4204
Mailing Address - Street 1:1023 ROCK BLVD
Mailing Address - Street 2:# C
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-0972
Mailing Address - Country:US
Mailing Address - Phone:775-358-4204
Mailing Address - Fax:775-358-4202
Practice Address - Street 1:1023 ROCK BLVD
Practice Address - Street 2:# C
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-0972
Practice Address - Country:US
Practice Address - Phone:775-358-4204
Practice Address - Fax:775-358-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV063067332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========OtherTAX ID
NV5500000001Medicare ID - Type Unspecified