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General NPI Number Information
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NPI Number | 1871986166
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Entity Type | Organization
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Legal Business Name | BETHESDA LAKE MEDICAL SUPPIES INC
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 4610 ARVILLE ST STE A
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City | LAS VEGAS
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State | NV
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Zip | 89103-5357
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Country | US
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Telephone | 702-882-0729
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Fax | 702-870-7878
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Provider Business Mailing Address
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Address Line | 4610 ARVILLE ST STE A
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City | LAS VEGAS
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State | NV
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Zip | 89103-5357
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Country | US
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Telephone | 702-882-0729
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Fax | 702-870-7878
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH CHRISTIAN BUBAN
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Credential |
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Telephone | 702-882-0729
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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 |
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License Number State |
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