Provider Demographics
NPI:1831323260
Name:MEKONG MARKETING, LLC
Entity Type:Organization
Organization Name:MEKONG MARKETING, LLC
Other - Org Name:MEKONG MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:SENBOUTHARATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-508-4803
Mailing Address - Street 1:3305 SPRING MOUNTAIN RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8609
Mailing Address - Country:US
Mailing Address - Phone:702-508-4803
Mailing Address - Fax:702-253-1748
Practice Address - Street 1:3305 SPRING MOUNTAIN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8609
Practice Address - Country:US
Practice Address - Phone:702-508-4803
Practice Address - Fax:702-253-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies