Healthcare Provider Details

I. General information

NPI: 1578064002
Provider Name (Legal Business Name): OPTIMUMEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E RENO AVE STE C9
LAS VEGAS NV
89119-1102
US

IV. Provider business mailing address

PO BOX 93056
LAS VEGAS NV
89193-3056
US

V. Phone/Fax

Practice location:
  • Phone: 844-888-8911
  • Fax: 702-435-7693
Mailing address:
  • Phone: 844-888-8911
  • Fax: 702-435-7693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateNV

VIII. Authorized Official

Name: DEVON K. EISMA
Title or Position: CEO
Credential:
Phone: 702-286-6490