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General NPI Number Information
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NPI Number | 1275616286
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Entity Type | Organization
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Legal Business Name | WMK, LLC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 2100 S DECATUR BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-8505
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Country | US
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Telephone | 702-876-9606
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Fax | 702-876-4366
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Provider Business Mailing Address
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Address Line | 2100 S DECATUR BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-8505
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Country | US
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Telephone | 702-876-9606
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Fax | 702-876-4366
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM KOEBLITZ
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Credential |
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Telephone | 234-678-4001
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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 | MP00287
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License Number State | NV
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