Healthcare Provider Details

I. General information

NPI: 1740343912
Provider Name (Legal Business Name): MOAPA VALLEY HOME MEDICAL CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 WEST PERKINS AVENUE
OVERTON NV
89040
US

IV. Provider business mailing address

PO BOX 1264
LOGANDALE NV
89021-1264
US

V. Phone/Fax

Practice location:
  • Phone: 702-398-7047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ERIC PAYNE
Title or Position: FACILITY ADMIN
Credential:
Phone: 702-371-6442