Nickes Medical Supply, LLC.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

NICKES MEDICAL SUPPLY, LLC.

Practice address

5443 Dudley Blvd BLDG 911
McClellan, CA 95652-1013

Phone

(915) 533-8870

Fax

(915) 533-0078

NPI assigned

Jul 2, 2019

Last updated

Jul 2, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ngozi Kathleen Austin-Eleje

Title

Owner/Manager

Phone

(915) 533-8870

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562025600000",
    "number": "1619539335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 N STANTON ST",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799022509",
            "telephone_number": "915-533-8870",
            "fax_number": "915-533-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5443 DUDLEY BLVD BLDG 911",
            "city": "MCCLELLAN",
            "state": "CA",
            "postal_code": "956521013",
            "telephone_number": "915-533-8870",
            "fax_number": "915-533-0078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICKES MEDICAL SUPPLY, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-02",
        "last_updated": "2019-07-02",
        "status": "A",
        "authorized_official_last_name": "AUSTIN-ELEJE",
        "authorized_official_first_name": "NGOZI",
        "authorized_official_middle_name": "KATHLEEN",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "915-533-8870"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in McClellan, CA
• Providers in McClellan, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.