MEDICARE: NEVA MED 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

General Provider Information

NPI Number	:	1497431027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVA MED SUPPLY LLC

Provider Business Mailing Address
First Line	:	4275 BURNHAM AVE STE 362
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4275 BURNHAM AVE STE 362
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8207
Country	:	US
Telephone Number	:	334-224-4383
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SHARYTA DENAE SIMMONS
Credential	:
Telephone Number	:	334-224-4383

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	06/27/2023

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Directions to “NEVA MED SUPPLY LLC ” Practice Location

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