Healthcare Provider Details

I. General information

NPI: 1700819786
Provider Name (Legal Business Name): NORTHERN NEVADA MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 GREG ST SUITE 102
SPARKS NV
89431-6073
US

IV. Provider business mailing address

1395 GREG ST SUITE 102
SPARKS NV
89431-6073
US

V. Phone/Fax

Practice location:
  • Phone: 775-824-9911
  • Fax: 775-824-9910
Mailing address:
  • Phone: 775-824-9911
  • Fax: 775-824-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberMP00387
License Number StateNV

VIII. Authorized Official

Name: DOUG CATTON
Title or Position: MANAGING MEMBER
Credential:
Phone: 775-824-9911