Provider Demographics
NPI:1912183559
Name:ST ROSE MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:ST ROSE MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSAYANREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-644-9034
Mailing Address - Street 1:80 N PECOS RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-3300
Mailing Address - Country:US
Mailing Address - Phone:702-644-9034
Mailing Address - Fax:702-644-9035
Practice Address - Street 1:80 N PECOS RD
Practice Address - Street 2:SUITE J
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-3300
Practice Address - Country:US
Practice Address - Phone:702-644-9034
Practice Address - Fax:702-644-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies