Organization Name: | IDEAL DIABETIC SUPPLIES LLC |
NPI Number: | 1841596129 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT BROKAW (MANAGER) |
Mailing Address: | 3031 Scenic Valley Way Henderson |
State: | NV US |
Postal Code: | 890523092 |
Phone Number: | 7024435878 |
Fax Number: | 8885919874 |
NPI Enumeration Date: | 02/02/2011 |
NPI Last Update Date: | 02/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | NV20101840350 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NV |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |