Provider Demographics
NPI:1922108737
Name:TROPICANA MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:TROPICANA MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-547-6017
Mailing Address - Street 1:5020 E TROPICANA AVE
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6747
Mailing Address - Country:US
Mailing Address - Phone:702-547-6017
Mailing Address - Fax:702-547-6019
Practice Address - Street 1:5020 E TROPICANA AVE
Practice Address - Street 2:SUITE B-5
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6749
Practice Address - Country:US
Practice Address - Phone:702-547-6017
Practice Address - Fax:702-547-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1000042-424332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV9429OtherBCBS
NV003302512Medicaid