=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740490747
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUN MEDICAL & MOBILITY EQUIPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 04/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6412 STORMY CREEK RD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89108-5328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-645-8008
-----------------------------------------------------
Fax | 702-448-5559
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6412 STORMY CREEK RD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89108-5328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-645-8008
-----------------------------------------------------
Fax | 702-448-5559
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ERIK V VALAINIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-645-8008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number | MW00024
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | MW00024
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | MW00024
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------