MEDICARE: MAM MEDICAL SUPPLY 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	2000087.424	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MP00124	OTHER	NV	NV. ST. BOARD OF PHARMACY

General Provider Information

NPI Number	:	1750387114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAM MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	2300 E DESERT INN RD
Second Line	:	STE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-3233
Country	:	US
Telephone Number	:	702-369-0510
Fax Number	:	702-369-9846

Provider Business Practice Location Address
First Line	:	2300 E DESERT INN RD
Second Line	:	STE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-3233
Country	:	US
Telephone Number	:	702-369-0510
Fax Number	:	702-369-9846

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ANA A. BEAVER
Credential	:
Telephone Number	:	702-369-0510

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	08/22/2020

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Directions to “MAM MEDICAL SUPPLY INC. ” Practice Location

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