Provider Demographics
NPI:1255099743
Name:PLATINUM MEDICAL SUPPLIES, LLC
Entity type:Organization
Organization Name:PLATINUM MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIZEL
Authorized Official - Middle Name:TRINIDAD
Authorized Official - Last Name:JACOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:702-601-8456
Mailing Address - Street 1:6000 S EASTERN AVE # 1B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-3125
Mailing Address - Country:US
Mailing Address - Phone:702-476-5597
Mailing Address - Fax:702-442-8797
Practice Address - Street 1:6000 S EASTERN AVE STE 1B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3125
Practice Address - Country:US
Practice Address - Phone:702-476-5597
Practice Address - Fax:702-442-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies