MEDICARE: SUN MEDICAL & MOBILITY EQUIPMENT

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	332BC3200X	Customized Equipment (DME)	MW00024	NV
2	332BX2000X	Oxygen Equipment & Supplies (DME)	MW00024	NV
3	332B00000X	Durable Medical Equipment & Medical Supplies	MW00024	NV

General Provider Information

NPI Number	:	1740490747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN MEDICAL & MOBILITY EQUIPMENT

Provider Business Mailing Address
First Line	:	6412 STORMY CREEK RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-5328
Country	:	US
Telephone Number	:	702-645-8008
Fax Number	:	702-448-5559

Provider Business Practice Location Address
First Line	:	6412 STORMY CREEK RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-5328
Country	:	US
Telephone Number	:	702-645-8008
Fax Number	:	702-448-5559

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERIK V VALAINIS
Credential	:
Telephone Number	:	702-645-8008

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	04/07/2008

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