MEDICARE: LYMPHEDEMA AND 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1689483455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYMPHEDEMA AND MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	8355 LAGUNILLA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4730
Country	:	US
Telephone Number	:	702-580-8125
Fax Number	:

Provider Business Practice Location Address
First Line	:	4215 S GRAND CANYON DR STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7173
Country	:	US
Telephone Number	:	702-448-6042
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	BRITTANY RONNEBAUM
Credential	:	PT, DPT
Telephone Number	:	702-580-8125

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/06/2025

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