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General NPI Number Information
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NPI Number | 1740050160
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Entity Type | Organization
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Legal Business Name | MEDICAL WIG SUPPLY
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Dates
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Enumeration Date | 01/05/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 7181 N HUALAPAI WAY STE 130-933
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City | LAS VEGAS
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State | NV
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Zip | 89166-1115
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Country | US
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Telephone | 702-904-2640
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Fax | 702-446-6290
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Provider Business Mailing Address
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Address Line | 7181 N HUALAPAI WAY STE 130-933
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City | LAS VEGAS
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State | NV
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Zip | 89166-1115
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Country | US
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Telephone | 702-904-2640
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Fax | 702-446-6290
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | NIKKI RACHAL
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Credential | MS
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Telephone | 702-904-2640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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