Healthcare Provider Details

I. General information

NPI: 1316297211
Provider Name (Legal Business Name): ON-TIME MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S MARYLAND PKWY SUITE #2
LAS VEGAS NV
89169-3098
US

IV. Provider business mailing address

3333 S MARYLAND PKWY SUITE #2
LAS VEGAS NV
89169-3098
US

V. Phone/Fax

Practice location:
  • Phone: 702-605-6905
  • Fax: 702-605-6906
Mailing address:
  • Phone: 702-605-6905
  • Fax: 702-605-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CANDIS HENDRIX
Title or Position: OWNER, ADMINISTRATOR
Credential:
Phone: 702-605-6905