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General NPI Number Information
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NPI Number | 1184991325
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Entity Type | Organization
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Legal Business Name | PRO COMFORT MEDICAL
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 101 S RAINBOW BLVD STE 15
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City | LAS VEGAS
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State | NV
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Zip | 89145-5362
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Country | US
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Telephone | 702-629-6818
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Fax | 702-993-8426
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Provider Business Mailing Address
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Address Line | 101 S RAINBOW BLVD STE 15
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City | LAS VEGAS
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State | NV
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Zip | 89145-5362
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Country | US
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Telephone | 702-629-6818
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Fax | 702-993-8426
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Authorized Official
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Title or Position | PRESIDENT
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Name | NATHAN HIGHAM
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Credential | CPED
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Telephone | 702-629-6818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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