MEDICARE: ENCHANTMENT 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

General Provider Information

NPI Number	:	1760433940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCHANTMENT MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	1557 MONTE VISTA AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5731
Country	:	US
Telephone Number	:	505-532-5700
Fax Number	:	505-432-5733

Provider Business Practice Location Address
First Line	:	1124 S SOLANO DR
Second Line	:	SUITE D
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3863
Country	:	US
Telephone Number	:	915-203-8108
Fax Number	:	505-532-5733

Authorized Official
Title or Position	:	OWNER
Name	:	GODWIN ENWONGOBONG UDO JR.
Credential	:
Telephone Number	:	915-203-8108

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	10/22/2007

Similar Medicare Providers

1265422885 — AMERICAN HOME MEDICAL EQUIPMENT INC
Practice Location Address:

3863 S VALLLEY VIEW , SUITE 11
LAS VEGAS, NV
89103-2944

Practice Phone: 702-395-1850
Practice Fax: 702-365-1853

1669530242 — MR. KEVEN THOMAS BAHOORA D.C.
Practice Location Address:

7035 W ANN RD , 160
LAS VEGAS, NV
89130-3863

Practice Phone: 702-396-0277
Practice Fax: 702-396-3790

1053530089 — DR. ANDREW CHARLES STUTZ D.D.S.
Practice Location Address:

7035 W ANN RD , SUITE # 110
LAS VEGAS, NV
89130-3863

Practice Phone: 702-396-2929
Practice Fax: 702-658-6435

1164786109 — DR. DOMINIQUE KATHERINE PITACCIO D.C.
Practice Location Address:

7035 W ANN RD , SUITE 160
LAS VEGAS, NV
89130-3863

Practice Phone: 702-396-0277
Practice Fax: 702-396-3790

1255769139 — PROTO SCRIPT PHARMACUETICALS CORP
Practice Location Address:

3863 S VALLEY VIEW BLVD , SUITE 11
LAS VEGAS, NV
89103-2910

Practice Phone: 702-366-0728
Practice Fax: 702-723-4969

1689063976 — JEAN R. YAN M.A.
Practice Location Address:

1492 LAS POSADAS DR
DUARTE, CA
91010-3863

Practice Phone: 626-757-8430
Practice Fax:

Directions to “ENCHANTMENT MEDICAL SUPPLY, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.