Provider Demographics
NPI:1851491864
Name:ESSENTIAL MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:ESSENTIAL MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-885-8612
Mailing Address - Street 1:3375 S DECATUR BLVD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8042
Mailing Address - Country:US
Mailing Address - Phone:702-341-1114
Mailing Address - Fax:702-364-1114
Practice Address - Street 1:3375 S DECATUR BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8042
Practice Address - Country:US
Practice Address - Phone:702-341-1114
Practice Address - Fax:702-364-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies