MEDICARE: LIFECARE MEDICAL SUPPLIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	005802700	NV
2	332BX2000X	Oxygen Equipment & Supplies (DME)	003302700	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285617761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFECARE MEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	6415 S FORT APACHE RD STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6747
Country	:	US
Telephone Number	:	702-696-1527
Fax Number	:	702-696-1591

Provider Business Practice Location Address
First Line	:	6415 S FORT APACHE RD STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6747
Country	:	US
Telephone Number	:	702-696-1527
Fax Number	:	702-696-1591

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CLETUS ONYE AMADI
Credential	:	MR.
Telephone Number	:	702-696-1527

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	08/30/2021

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