MEDICARE: PLATINUM MEDICAL SUPPLIES, 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	332BX2000X	Oxygen Equipment & Supplies (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1255099743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATINUM MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	6000 S EASTERN AVE # 1B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3125
Country	:	US
Telephone Number	:	702-476-5597
Fax Number	:	702-442-8797

Provider Business Practice Location Address
First Line	:	6000 S EASTERN AVE STE 1B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3125
Country	:	US
Telephone Number	:	702-476-5597
Fax Number	:	702-442-8797

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LEIZEL TRINIDAD JACOBSEN
Credential	:	RT
Telephone Number	:	702-601-8456

Provider Enumeration Date	:	12/02/2021
Last Update Date	:	07/28/2022

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