Provider Demographics
NPI:1265602296
Name:VEGAS MEDICAL SUPPLIES CORP.
Entity type:Organization
Organization Name:VEGAS MEDICAL SUPPLIES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-638-7900
Mailing Address - Street 1:3111 S VALLEY VIEW BLVD
Mailing Address - Street 2:STE A-105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8317
Mailing Address - Country:US
Mailing Address - Phone:702-638-7900
Mailing Address - Fax:702-638-7901
Practice Address - Street 1:3111 S VALLEY VIEW BLVD
Practice Address - Street 2:STE A-105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8317
Practice Address - Country:US
Practice Address - Phone:702-638-7900
Practice Address - Fax:702-638-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000134-424332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6155250001Medicare NSC