=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023355450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMS SURGICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2013
-----------------------------------------------------
Last Update Date | 01/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7446 BERMUDA ISLAND ST
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89123-1173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-808-2998
-----------------------------------------------------
Fax | 866-496-5083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7446 BERMUDA ISLAND ST
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89123-1173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-808-2998
-----------------------------------------------------
Fax | 866-496-5083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPLE
-----------------------------------------------------
Name | MR. MANUEL PERALES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-808-2998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------