Provider Demographics
NPI:1801980719
Name:CAROL'S POST MASTECTOMY SPECIALIST INC
Entity type:Organization
Organization Name:CAROL'S POST MASTECTOMY SPECIALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:STENQUIST
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-568-9595
Mailing Address - Street 1:72 N PECOS RD STE B
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7346
Mailing Address - Country:US
Mailing Address - Phone:702-568-9595
Mailing Address - Fax:702-933-4051
Practice Address - Street 1:72 N PECOS RD STE B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074
Practice Address - Country:US
Practice Address - Phone:702-568-9595
Practice Address - Fax:702-933-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003302342Medicaid
NV4395130001Medicare NSC