Healthcare Provider Details

I. General information

NPI: 1255099743
Provider Name (Legal Business Name): PLATINUM MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 S EASTERN AVE STE 1B
LAS VEGAS NV
89119-3125
US

IV. Provider business mailing address

6000 S EASTERN AVE # 1B
LAS VEGAS NV
89119-3125
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-5597
  • Fax: 702-442-8797
Mailing address:
  • Phone: 702-476-5597
  • Fax: 702-442-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEIZEL TRINIDAD JACOBSEN
Title or Position: ADMINISTRATOR
Credential: RT
Phone: 702-601-8456