Healthcare Provider Details

I. General information

NPI: 1851428973
Provider Name (Legal Business Name): DME EXPRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 BANBURRY CROSS DR SUITE 290
LAS VEGAS NV
89144-7056
US

IV. Provider business mailing address

10050 BANBURRY CROSS DR SUITE 290
LAS VEGAS NV
89144-7056
US

V. Phone/Fax

Practice location:
  • Phone: 702-248-5108
  • Fax: 702-365-1189
Mailing address:
  • Phone: 702-248-5108
  • Fax: 702-365-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1002710596
License Number StateNV

VIII. Authorized Official

Name: MR. DENNIS M SPONER
Title or Position: PRESIDENT CEO
Credential:
Phone: 702-248-5108