MEDICARE: WARREN L SMITH

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	:	1700088713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARREN L SMITH

Provider Business Mailing Address
First Line	:	706 WELLS RD
Second Line	:
City	:	BOULDER CITY
State	:	NV
Zip	:	89005-1838
Country	:	US
Telephone Number	:	702-294-0055
Fax Number	:	702-294-0649

Provider Business Practice Location Address
First Line	:	706 WELLS RD
Second Line	:
City	:	BOULDER CITY
State	:	NV
Zip	:	89005-1838
Country	:	US
Telephone Number	:	702-294-0055
Fax Number	:	702-294-0649

Authorized Official
Title or Position	:	GENERAL MANAGER COO
Name	:	MRS. BRANDY D SMITH
Credential	:	MBA
Telephone Number	:	702-294-0055

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	06/19/2008

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