MEDICARE: LV MEDICAL SUPPLY SERVICE INC

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

General Provider Information

NPI Number	:	1407025026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LV MEDICAL SUPPLY SERVICE INC

Provider Business Mailing Address
First Line	:	3201 N 16TH ST
Second Line	:	STE 12
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7160
Country	:	US
Telephone Number	:	602-279-2008
Fax Number	:	480-445-9790

Provider Business Practice Location Address
First Line	:	3201 N 16TH ST
Second Line	:	STE 12
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7160
Country	:	US
Telephone Number	:	602-279-2008
Fax Number	:	602-445-9125

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GRACIELA VELDERRAIN
Credential	:
Telephone Number	:	602-279-2008

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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