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General NPI Number Information
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NPI Number | 1316010432
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Entity Type | Organization
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Legal Business Name | MESQUITE MEDICAL EQUIPMENT
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 330 FALCON RIDGE PKWY STE 400B
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City | MESQUITE
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State | NV
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Zip | 89027
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Country | US
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Telephone | 702-345-4625
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Fax | 702-346-1789
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Provider Business Mailing Address
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Address Line | PO BOX 2885
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City | MESQUITE
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State | NV
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Zip | 89024-2885
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHELLE WAKEFIELD
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Credential |
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Telephone | 702-345-4625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 149134400
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License Number State | NV
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