MEDICARE: LIFECARE MEDICAL SUPPLIES WEST 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	NV20161145074	NV

General Provider Information

NPI Number	:	1578912861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFECARE MEDICAL SUPPLIES WEST INC

Provider Business Mailing Address
First Line	:	6415 S FORT APACHE RD
Second Line	:	STE#175
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6744
Country	:	US
Telephone Number	:	702-722-2126
Fax Number	:

Provider Business Practice Location Address
First Line	:	6415 S FORT APACHE RD
Second Line	:	STE#175
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6744
Country	:	US
Telephone Number	:	702-722-2126
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CLETUS O AMADI
Credential	:
Telephone Number	:	702-303-6790

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	06/07/2016

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