MEDICARE: MT MEDICAL SUPPLIES

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	H13002994131149	NV

General Provider Information

NPI Number	:	1568532356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	2451 N RAINBOW BLVD
Second Line	:	UNIT 1097
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4502
Country	:	US
Telephone Number	:	702-396-8423
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 N RAINBOW BLVD
Second Line	:	UNIT 1097
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4502
Country	:	US
Telephone Number	:	702-396-8423
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MICHELLE JEFFERSON MERIDETH
Credential	:
Telephone Number	:	702-396-8423

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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Directions to “MT MEDICAL SUPPLIES ” Practice Location

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