NPIMap

Organization Active NPI

Divine Providence Inc

  • Durable Medical Equipment & Medical Supplies
  • Las Vegas, NV
National Provider Identifier
1558824607
Registry record updated Apr 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
DIVINE PROVIDENCE INC
Practice address
1729 E Charleston Blvd Ste F
Las Vegas, NV 89104-1986
Phone
(954) 663-1759
NPI assigned
Apr 6, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2019

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

Authorized official

Name
Dr. Modupe IrorobejeNPI 1184405953
Title
Ceo
Phone
(702) 778-3072

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

1729 E Charleston Blvd Ste F
Las Vegas, NV 89104-1986

Mailing address

11055 Kilkerran CT
Las Vegas, NV 89141-4356
Phone (954) 663-1759

Other names 1

  • providence medical supply Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL providencepharmacy1@gmail.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1554508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554508800000",
    "number": "1558824607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11055 KILKERRAN CT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891414356",
            "telephone_number": "954-663-1759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1729 E CHARLESTON BLVD STE F",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891041986",
            "telephone_number": "954-663-1759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PROVIDENCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-06",
        "last_updated": "2019-04-06",
        "status": "A",
        "authorized_official_last_name": "IROROBEJE",
        "authorized_official_first_name": "MODUPE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-778-3072",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "providencepharmacy1@gmail.com",
            "affiliation": "N",
            "endpointDescription": "medical supply",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1729 E Charleston Blvd Ste F",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891041986",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "providence 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 Apr 6, 2019; 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.