Provider Demographics
NPI:1740050160
Name:MEDICAL WIG SUPPLY
Entity type:Organization
Organization Name:MEDICAL WIG SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:RACHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:702-904-2640
Mailing Address - Street 1:7181 N HUALAPAI WAY STE 130-933
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-1115
Mailing Address - Country:US
Mailing Address - Phone:702-904-2640
Mailing Address - Fax:702-446-6290
Practice Address - Street 1:7181 N HUALAPAI WAY STE 130-933
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-1115
Practice Address - Country:US
Practice Address - Phone:702-904-2640
Practice Address - Fax:702-446-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier