Provider Demographics
NPI:1790734234
Name:PATRICIAS ENTERPRISES
Entity Type:Organization
Organization Name:PATRICIAS ENTERPRISES
Other - Org Name:OWENS ST MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SAULTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-648-4440
Mailing Address - Street 1:1240 W OWENS AVENUE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2452
Mailing Address - Country:US
Mailing Address - Phone:702-648-4440
Mailing Address - Fax:702-648-8499
Practice Address - Street 1:1240 W OWENS AVENUE
Practice Address - Street 2:SUITE 6
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2452
Practice Address - Country:US
Practice Address - Phone:702-648-4440
Practice Address - Fax:702-648-8499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVH13002681120197332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5446190001Medicare ID - Type Unspecified