NPIMap

Organization Active NPI

Emerald Lake, Inc

  • Durable Medical Equipment & Medical Supplies
  • Las Vegas, NV
National Provider Identifier
1295956233
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
EMERALD LAKE, INC
Practice address
500 S Martin L King Blvd Ste D
Las Vegas, NV 89106-4424
Phone
(702) 678-6776
Fax
(702) 678-6661
NPI assigned
May 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marcel Ezeoke, RPH
Title
Manager
Phone
(702) 678-6776

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NV Primary

Addresses

Primary practice location

500 S Martin L King Blvd Ste D
Las Vegas, NV 89106-4424

Mailing address

500 S Martin L King Blvd Ste D
Las Vegas, NV 89106-4424
Phone (702) 678-6776

Other names 1

  • emerald medical supply Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Emerald Lake Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295956233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S MARTIN L KING BLVD STE D",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064424",
            "telephone_number": "702-678-6776",
            "fax_number": "702-678-6661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S MARTIN L KING BLVD STE D",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064424",
            "telephone_number": "702-678-6776",
            "fax_number": "702-678-6661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD LAKE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EZEOKE",
        "authorized_official_first_name": "MARCEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-678-6776",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "emerald medical supply",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.