Provider Demographics
NPI:1972912475
Name:TOBIN MEDICAL LLC
Entity Type:Organization
Organization Name:TOBIN MEDICAL LLC
Other - Org Name:TOBIN MEDICAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-583-6192
Mailing Address - Street 1:4815 W RUSSELL RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-6242
Mailing Address - Country:US
Mailing Address - Phone:702-583-6192
Mailing Address - Fax:702-637-7691
Practice Address - Street 1:4815 W RUSSELL RD STE 1A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-6242
Practice Address - Country:US
Practice Address - Phone:702-583-6192
Practice Address - Fax:702-637-7691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141499260332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157505OtherPK
2157505OtherPK