Emerald Lake, Inc

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

MP00814 Issued in NV

Legal business name

EMERALD LAKE, INC

Practice address

5243 W Charleston Blvd Ste 9
Las Vegas, NV 89146-1304

Phone

(702) 678-6267

Fax

(702) 474-7051

NPI assigned

Feb 12, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Kelechi Agwara

Title

Director

Phone

(702) 678-6267

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• EMERALD MEDICAL SUPPLIES Doing business as

Locations

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449100800000",
    "number": "1578605341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5243 W CHARLESTON BLVD STE 9",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461304",
            "telephone_number": "702-678-6267",
            "fax_number": "702-474-7051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5243 W CHARLESTON BLVD STE 9",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461304",
            "telephone_number": "702-678-6267",
            "fax_number": "702-474-7051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD LAKE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2015-12-03",
        "status": "A",
        "authorized_official_last_name": "AGWARA",
        "authorized_official_first_name": "KELECHI",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "702-678-6267",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NV",
            "license": "MP00814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3302694",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EMERALD MEDICAL SUPPLIES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oxygen Equipment & Supplies (DME) in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Oxygen Equipment & Supplies (DME) in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2015; 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.