Healthcare Provider Details

I. General information

NPI: 1295079978
Provider Name (Legal Business Name): ACCELLENCE LAS VEGAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 W RUSSELL RD STE 4D
LAS VEGAS NV
89118-6241
US

IV. Provider business mailing address

35 N EDISON WAY STE 37
RENO NV
89502-2352
US

V. Phone/Fax

Practice location:
  • Phone: 702-740-4138
  • Fax: 702-740-4153
Mailing address:
  • Phone: 775-787-8880
  • Fax: 775-352-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1000087786
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1000087786
License Number StateNV

VIII. Authorized Official

Name: JOHN R HOWITT
Title or Position: MANAGER
Credential: R.R.T, ATP
Phone: 775-787-8880