MEDICARE: FREEDOM MEDICAL SUPPLY LLC

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	NV20101789254	NV

General Provider Information

NPI Number	:	1659828739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	8868 S EASTERN AVE
Second Line	:	115
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-4823
Country	:	US
Telephone Number	:	702-386-9997
Fax Number	:	702-228-9996

Provider Business Practice Location Address
First Line	:	8868 S EASTERN AVE
Second Line	:	115
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-4823
Country	:	US
Telephone Number	:	702-386-9997
Fax Number	:	702-228-9996

Authorized Official
Title or Position	:	OWNER
Name	:	BRAD G MAURER
Credential	:
Telephone Number	:	702-386-9997

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	09/06/2016

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