Healthcare Provider Details

I. General information

NPI: 1740490747
Provider Name (Legal Business Name): SUN MEDICAL & MOBILITY EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6412 STORMY CREEK RD
LAS VEGAS NV
89108-5328
US

IV. Provider business mailing address

6412 STORMY CREEK RD
LAS VEGAS NV
89108-5328
US

V. Phone/Fax

Practice location:
  • Phone: 702-645-8008
  • Fax: 702-448-5559
Mailing address:
  • Phone: 702-645-8008
  • Fax: 702-448-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMW00024
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberMW00024
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberMW00024
License Number StateNV

VIII. Authorized Official

Name: MR. ERIK V VALAINIS
Title or Position: PRESIDENT
Credential:
Phone: 702-645-8008