MEDICARE: DME OF LAS VEGAS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332BC3200X	Customized Equipment (DME)
2	332BD1200X	Dialysis Equipment & Supplies (DME)
3	332BN1400X	Nursing Facility Supplies (DME)
4	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
5	332BX2000X	Oxygen Equipment & Supplies (DME)
6	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1194385484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DME OF LAS VEGAS

Provider Business Mailing Address
First Line	:	4904 CAMINO AL NORTE # 336241
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-9995
Country	:	US
Telephone Number	:	866-332-2330
Fax Number	:	702-202-3668

Provider Business Practice Location Address
First Line	:	4133 MANTLE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2653
Country	:	US
Telephone Number	:	866-332-2330
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RAY MCINTOSH
Credential	:
Telephone Number	:	866-332-2330

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	06/18/2019

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Directions to “DME OF LAS VEGAS ” Practice Location

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