MEDICARE: SUNRISE MEDICAL SUPPLY L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	2000148.424	NV

General Provider Information

NPI Number	:	1134306715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE MEDICAL SUPPLY L.L.C.

Provider Business Mailing Address
First Line	:	1305 VEGAS VALLEY DR STE F
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-6217
Country	:	US
Telephone Number	:	702-732-8999
Fax Number	:	702-360-6966

Provider Business Practice Location Address
First Line	:	1305 VEGAS VALLEY DR STE F
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-6217
Country	:	US
Telephone Number	:	702-732-8999
Fax Number	:	702-360-6966

Authorized Official
Title or Position	:	MANAGER/PARTNER
Name	:	MRS. ARMINE AMY MADZHARYAN
Credential	:
Telephone Number	:	702-403-4433

Provider Enumeration Date	:	01/26/2008
Last Update Date	:	01/26/2008

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