Healthcare Provider Details

I. General information

NPI: 1922108737
Provider Name (Legal Business Name): TROPICANA MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 E TROPICANA AVE SUITE B-5
LAS VEGAS NV
89122-6749
US

IV. Provider business mailing address

5020 E TROPICANA AVE SUITE B-5
LAS VEGAS NV
89122-6747
US

V. Phone/Fax

Practice location:
  • Phone: 702-547-6017
  • Fax: 702-547-6019
Mailing address:
  • Phone: 702-547-6017
  • Fax: 702-547-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1000042-424
License Number StateNV

VIII. Authorized Official

Name: JERMAINE A. THOMAS
Title or Position: MANAGER
Credential:
Phone: 702-547-6017