MEDICARE: FREEDOM MEDICAL SUPPLY LLC

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	MP00256	NV

General Provider Information

NPI Number	:	1235430349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	8040 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2526
Country	:	US
Telephone Number	:	702-386-9997
Fax Number	:	702-228-9996

Provider Business Practice Location Address
First Line	:	8040 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2526
Country	:	US
Telephone Number	:	702-386-9997
Fax Number	:	702-228-9996

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. BRADLEY G MAURER
Credential	:
Telephone Number	:	702-386-9997

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	06/30/2023

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