MEDICARE: DMEONTHEGOLLC

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1134684954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DMEONTHEGOLLC

Provider Business Mailing Address
First Line	:	4904 CAMINO AL NORTE
Second Line	:
City	:	N. LAS VEGAS
State	:	NV
Zip	:	89094
Country	:	US
Telephone Number	:	800-625-4814
Fax Number	:

Provider Business Practice Location Address
First Line	:	4904 CAMINO AL NORTE
Second Line	:
City	:	N. LAS VEGAS
State	:	NV
Zip	:	89094
Country	:	US
Telephone Number	:	800-625-4814
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MS. DEBBIE DENISE WASHINGTON
Credential	:
Telephone Number	:	800-625-4814

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	02/06/2019

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Directions to “DMEONTHEGOLLC ” Practice Location

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