MEDICARE: MEKONG MARKETING, 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	:	1831323260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEKONG MARKETING, LLC

Provider Business Mailing Address
First Line	:	3305 SPRING MOUNTAIN RD
Second Line	:	SUITE 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8609
Country	:	US
Telephone Number	:	702-508-4803
Fax Number	:	702-253-1748

Provider Business Practice Location Address
First Line	:	3305 SPRING MOUNTAIN RD
Second Line	:	SUITE 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8609
Country	:	US
Telephone Number	:	702-508-4803
Fax Number	:	702-253-1748

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JACK SENBOUTHARATH
Credential	:
Telephone Number	:	702-508-4803

Provider Enumeration Date	:	05/13/2009
Last Update Date	:	05/13/2009

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